Literature Review

United Palliative & Hospice Care accused of $87M hospice scam Hospice News; by Jim Parker; 7/2/25 Three women associated with Houston-based United Hospice & Palliative Care (UPHC) have been charged with Medicaid and Medicare fraud after allegedly bilking more than $87 million in federal health care funds. The trio includes UPHC owner Dera Ogudo, an UPHC employee Victoria Martinez and a psychiatric hospital employee, Evelyn Shaw, ABC-13 Houston reported. The prosecutor’s indictment also includes an unnamed physician who allegedly received kickbacks for referrals to UPHC. “Ogudo and her co-conspirators preyed on the vulnerable residents of those group homes by enrolling them in hospice services with UPHC when they were not terminally ill,” the indictment indicated.

CMS to test prior authorization model in traditional Medicare MedPageToday; by Joyce Frieden; 6/30/25 The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model late last week to streamline some prior authorizations under the traditional Medicare program, but some politicians and experts are concerned that it could result in more delays in care. Under the model, known as the Wasteful and Inappropriate Service Reduction (WISeR) Model, "CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process" under traditional Medicare, the agency said Friday [6/27] in a press release ...

The Alliance Responds to CY 2026 Home Health Proposed RuleNational Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 6/20/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2026 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule, which proposes payment and regulatory updates for Medicare home health agencies (HHAs). The proposed rule includes policies that would reduce payments to HHAs by over $1 billion dollars in 2026, at a time when providers also continue to experience unmatched inflationary pressure in a challenging labor market — making it difficult, if not impossible in some areas, to deliver care to Medicare beneficiaries entitled to receive it.

California man pleads guilty in connection with laundering proceeds of $16M hospice fraud schemeUS Department of Justice press release; 6/23/25A California man pleaded guilty today to laundering more than $4.6 million in connection with a years-long scheme to defraud Medicare of nearly $16 million through sham hospice companies. According to court documents, Mihran Panosyan, ...worked with others to launder the proceeds of a massive Medicare fraud scheme, transferring the fraudulently obtained funds between multiple accounts before spending them. The scheme comprised three parts. First, three of Panosyan’s co-defendants used the identities of foreign nationals no longer in the United States to operate several sham hospice companies... Second, the co-defendants caused the submission of false and fraudulent claims to Medicare for hospice services for patients who were not terminally ill and who never requested nor received hospice services... Third, Panosyan and his co-defendants laundered the proceeds of the scheme to conceal the source of the funds and their control over them... He faces a maximum penalty of 20 years in prison.

MedPAC releases June 2025 report on Medicare and the health care delivery systemMedPAC press release; 6/12/25The Medicare Payment Advisory Commission (MedPAC) today releases its June 2025 Report to the Congress: Medicare and the Health Care Delivery System. Each June, as part of its mandate from the Congress, MedPAC reports on issues affecting the Medicare program as well as broader changes in health care delivery and the market for health care services.

Families demand end to Medicare waiting period for early-onset Alzheimer’s patients Washington Examiner; by Elaine Mallon; 6/15/25 Jason Raubach was diagnosed at 50 years old with early-onset Alzheimer’s disease — a diagnosis that affects nearly 200,000 Americans. He received the diagnosis in 2018, completely upending life for his family. His youngest child was just a freshman in high school. ... Shortly before receiving an official diagnosis, Jason Raubach lost his job, having to move his family onto a consolidated omnibus budget reconciliation act health plan, or COBRA plan, which allows a person to keep their health insurance even after losing their job. “It wasn’t cheap,” Elizabeth Raubach said.However, once diagnosed, Jason Raubach had to wait two and a half years before he could receive coverage under Medicare, health insurance for those 65 years and older or those with qualifying disabilities. But Elizabeth Raubach, along with dozens of other caretakers for people diagnosed with Alzheimer’s, called on Congress in a letter to eliminate the 29-month waiting period required for those under the age of 65 to receive coverage under Medicare. ...

Alliance official: Medicare Advantage growth, PDGM cuts create converging crises for at-home care Home Health Care News; by Morgan Gonzales; 6/13/25 At-home care is reaching a crisis point, according to Scott Levy, chief government affairs officer  at the National Alliance for Care at Home (the Alliance). The pressure on providers is not only unsustainable – it threatens access to cost-saving in-home care. Already, over one-third of patients referred to home health fail to receive those services. Home health is facing a triple threat, with deepening patient-driven groupings model (PDGM) payment cuts, Medicare rate updates that fail to keep up with real inflation and increased Medicare Advantage (MA) penetration. Meanwhile, home- and community-based services are in the crosshairs of the budget reconciliation bill passed by Congress and now in the Senate’s hands. Access to care is sure to be impacted, Levy said, but questions remain as to what extent. ...

Chapter 6: Medicare’s measurement of rural provider quality MedPAC; 6/12/25 ... Because of low patient volumes in many rural health care settings, there are practical challenges in measuring some individual rural providers’ quality of care and in holding these providers accountable in quality reporting programs. ... The Commission acknowledged these difficulties when it established specific principles to guide expectations about quality in rural areas. These principles were developed with hospitals in mind but could be applied to other providers. ... [On page 4 of 40] Rural skilled nursing facilities and dialysis facilities had lower shares of providers with publicly reported quality results compared with their urban counterparts; in contrast, rural home health agencies and hospices had higher shares of providers with publicly reported quality results compared with their urban counterparts.Editor's Note: For ranking of hospices by quality scores, examine the National Hospice Locator, provided to the public by Hospice Analytics (a sponsor of this newsletter). 

CMS budget proposal would shift nursing facility oversight Becker's Hospital Review; by Elizabeth Gregerson; 6/4/25 Key changes put forth in President Donald Trump’s proposed fiscal year 2026 budget may have downstream effects on the survey and certification of skilled nursing facilities. ... Here are three things to know about the proposed changes:

Experts warn of scams during Medicare Fraud Prevention Week Public News Service; by Suzanne Potter; 6/4/25 Medicare loses $60 billion to $80 billion a year to fraud and this year, for Medicare Fraud Prevention Week, your local Senior Medicare Patrol has good advice on how to spot a con. There are plenty of scams to be aware of. Karen Joy Fletcher, communications director with the nonprofit California Health Advocates, said beware if a caller asks to verify your Medicare number, claiming the program needs to send out a new type of card. ... ... Caregivers can be on the lookout for medical equipment arriving at the house even though the beneficiary never ordered it. Another red flag? A stranger may approach you in a parking lot asking you to sign up for new, free Medicare services like house cleaning or meals, which are then fraudulently billed to the government. ... Another scam involves tricking people into unknowingly signing up for hospice care. It is especially dangerous, because once a person is on hospice, Medicare will only approve palliative care and could mistakenly deny an essential surgery or medication.

HHS faces $31B cuts in proposed FY ’26 budget: 6 notes Becker's Hospital Review; by Madeline Ashley; 6/2/25 President Donald Trump’s proposed fiscal 2026 budget slashes funding for the National Institutes of Health by $18 billion to $27.5 billion as part of a sweeping overhaul to realign federal healthcare spending.  The NIH received $46.4 billion in program level funding in 2024 and just over $46 billion in 2025, according to the budget proposal. [Continue reading for this article's lists of (1) consolidated institutes and centers; and (2) "six things to know."]

CMS’s Hospice Star Rating System limited by missing data Health Affairs; by Amanda C. Chen and David C. Grabowski; 6/3/25 Two-thirds of US hospices were not given a star rating when the Centers for Medicare and Medicaid Services (CMS) introduced its hospice star rating system in 2022. Since then, the share of hospices without a star rating has steadily increased, including through the most recent reporting period of 2024. This suggests that the CMS hospice star rating is having limited impact. We provide recommendations for CMS and other policy makers to improve the value for hospice patients of publicly reported star ratings.