Literature Review

How closed-ended survey questions and narrative comments interact in characterizing caregivers’ overall assessment of hospice care Rand.org, published in American Journal of Hospice and Palliative Medicine; by Denise D. Quigley, Anagha Alka Tolpadi, Danielle Schlang, Joshua Wolf, Rebecca Anhang Price, Melissa A. Bradley; April 2026 online ahead of  print Introduction: Responses to open-ended questions on experience surveys provide rich information and are useful for quality improvement (QI). We examine the usefulness of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey comments for informing hospice QI.Conclusion: Closed-ended questions on the CAHPS Hospice Survey elicit comprehensive insights on hospice care experiences. While many caregivers elected to provide open-ended feedback, a minority of these comments were actionable for QI, and comments did not provide substantial, unique information. CAHPS Hospice Survey measures are sufficient, without open-ended comments, to guide QI, prioritize actions, benchmark performance and assist caregivers in hospice selection.

Aetna agrees to pay $117.7 million to resolve false claims act allegationsDOJ press release; 3/11/26Aetna Inc., a national insurer incorporated under the laws of Pennsylvania, has agreed to pay $117,700,000 to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare.

The measure isn’t wrong. The story is incomplete. McKnights Long-Term Care News; by Steven Littlehale; 2/27/26 Not long ago, I was sitting across from a nursing home leadership team as they stared at a quality measure report that didn’t make sense to them. ... So we did what more facilities should do when a QM score feels off: We stopped looking at the rating and started looking at the math. That’s where the real story surfaced. It wasn’t about poor care, but about exclusions not captured, covariates not fully coded, and pieces of the clinical picture that never made it into the structured data fields the Centers for Medicare & Medicaid Services reads. 

Apex Hospice, ex-director settle False Claims retaliation suit Bloomberg Law; by Daniel Seiden; 2/20/26 Illinois-based Apex Hospice & Palliative Care Inc. and its former medical director reached a confidential settlement of a False Claims Act suit alleging the company fired her in retaliation for calling attention to Medicare fraud, a federal district court said Friday. Janice Makela’s suit is dismissed without prejudice, Chief Judge Virginia M. Kendall of the US District Court for the Northern District of Illinois said in an order.

14th Annual healthcare fraud & abuse review 2025 JD Supra; by Theresa Androff, Cody Anthony, Denise Barnes, Michael Bassham, Angela Bergman, Justin Brown, Nathan Brown, J. Taylor Chenery, Hannah Choate, Matthew Curley, John Eason, Charlotte Elam, Emily Ann Farmer, Lindsey Brown Fetzer, Emily Fountain, Lauren Gaffney, Scott Gallisdorfer, Anna Grizzle, Becca Guthrie, Stephanie Higdon, Brian Irving, Stewart Kameen, Travis Lloyd, Andrés Martinez, Garrah Carter-Mason, William Mathias, Jennifer Michael, Jack Nelson, Benjamin Peterson, Brianna Powell, Lisa Rivera, Brian Roark, Molly Ruberg, Taylor Sample, Reagan Schmidt, Ben Schrader, Danielle Sloane, Hannah Webber; 2/17/26 Bass, Berry & Sims is pleased to bring you our 14th annual Healthcare Fraud & Abuse Review in which we cover significant civil and criminal enforcement issues for healthcare providers. Please see full publication below for more information. ...

FWA Insights: The top fraud schemes of 2025 COTIVITI | Fraud, Waste, and Abuse; by Erin Rutzler, AHFI, CFE, CHC, CPC; 2/10/26 Throughout 2025, federal and state authorities uncovered schemes involving everything from unnecessary lab tests to fraudulent telehealth services and hospice care. These cases highlight the evolving tactics bad actors use to exploit vulnerabilities—and the urgent need for payers to stay vigilant. While the methods vary, the goal is the same: profit at the expense of patients and payers. In our latest edition of FWA Insights, we break down three major categories of FWA—lab testing, home health and hospice, and telehealth—with real-world examples from 2025 and recommendations for mitigating these risks.

Forefront Living Hospice agreed to pay $1.9 million for allegedly violating the Civil Monetary Penalties Law by submitting claims for services that identified the incorrect provider or were performed by non-enrolled or incorrect providers HHS-OIG, U.S. Government; 1/30/26 After it self-disclosed conduct to OIG, Forefront Living Hospice d/b/a Faith Presbyterian Hospice and d/b/a T. Bonne Pickens Hospice and Palliative Care Center (Forefront), Dallas, Texas, agreed to Pay $1,959,718.74 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Forefront billed for: (1) hospice services provided by "attending physicians" who were nurse practitioners, but billed as if they had been performed by physicians; and (2) "attending physician" services performed by an attending physician who was not the physician chosen by the patient or where the provider was not properly enrolled in Medicare.

Measures that matter: How better metrics can transform end-of-life care | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Bob Tavares, Robin Heffernan and Mindy Stewart-Coffee; 2/4/26 In Episode One of Measures That Matter: How Better Metrics Can Transform End-of-Life Care ... explores why fewer, clearer quality measures are essential for reducing variability, improving patient outcomes, and supporting value-based care at the end of life. ... Bob Tavares explains how decades of healthcare analytics revealed a fundamental problem in Hospice quality measurement: an abundance of metrics that fail to differentiate performance.  Many current measures cluster nearly all providers at the top, making it difficult for patients, payers, and value-based organizations to identify true centers of excellence or address variability that puts patients at risk.

CMS announces $50 billion Rural Health Transformation Program: What providers and states need to know JD Supra; by Margia Corner, Alexandria Foster, Kendall Kohlmeyer; 2/2/26On December 29, 2025, the Centers for Medicare & Medicaid Services (“CMS”) announced that it will distribute award amounts to all 50 states under the first year of the Rural Health Transformation Program (the “Program”). ... The Program’s $50 billion in funds will be allocated over five years, with $10 billion available each year beginning in 2026. ... Under Public Law 119-21, funding must be distributed to states as follows: ...

MedPAC signals need to bolster Medicare physician payments AMA - American Medical Association; by Tanya Albert Henry; 1/27/26 Influential body backs added 0.5% Medicare pay update but backtracks on linking doctor payment to practice-cost inflation. ... The influential Medicare Payment Advisory Commission (MedPAC) voted in January to address inadequate payment for Medicare physician services under current law, once again underscoring a longstanding policy failure that is widely recognized but remains unresolved. MedPAC voted to recommend an additional 0.5% update on top of the updates specified in current law—0.25% and 0.75%—and will forward that recommendation to Congress. 

False Claims Act 2025 year-end update Gibson, Dunn & Crutcher; Press Release; 1/27/26 This update covers recent developments in FCA jurisprudence, summarizes significant enforcement activity, and analyzes the most notable legislative, policy, and caselaw developments from the second half of calendar year 2025, picking up where our mid-year 2025 update left off.

HHS-OIG Semiannual Report to Congress: April 1 - September 30, 2025 HHS Office of Inspector General; by the OIG; 1/21/26 OIG publishes the Fall 2025 Semiannual Report to Congress. Also posts two enforcement actions.Fall 2025 Semiannual Report to Congress Today, OIG released its Fall 2025 Semiannual Report to Congress, summarizing its activities and accomplishments from April 1, 2025, through September 30, 2025. The report outlines OIG’s work to address fraud, waste, abuse and mismanagement across HHS programs—and driving change through oversight and accountability. OIG's efforts during this period led to a total monetary impact of $2.43 billion, demonstrating the agency’s role in protecting taxpayer funds and improving program performance. Read the full report now to understand how OIG is working to safeguard taxpayer dollars and enhance government performance. 

Update your HIPAA Notice of Privacy Practices by February 16, 2026 The National Law Review; by John D. Arendshorst , Charles M. Russman, Carolyn M. H. Sullivan, Kristy L. De Vos, Varnum LLP; 1/21/26 Whether your company provides health benefits or qualifies as a covered entity under the Health Insurance Portability and Accountability Act (HIPAA), it is important to update your Notice of Privacy Practices (NPP) by February 16, 2026, to remain HIPAA compliant. The updated requirements focus on how substance use disorder information may be used or disclosed and remove reproductive health language that was previously added but has since been revoked. ... [Additionally]: