Literature Review

DOJ’s National Fraud Enforcement Division announces priorities ReedSmith; by Scot T. Hasselman, Selina P. Coleman, Matthew K. Loughran; 8/14/26 In an August 13 memo, Assistant Attorney General Colin M. McDonald set forth the priorities of the Department of Justice (DOJ) National Fraud Enforcement Division that will be focused primarily on criminal public benefits fraud and misuse of taxpayer dollars. In the health care space, the primary targets in include home health agencies and hospice providers, as well as pharmacists and physicians who may be involved in drug diversion. ... The McDonald memo details some of the efforts that the division will focus on when attempting to combat health care fraud. According to the memo, approximately 3 to 10 percent of all health care spending is the result of fraud. ... While the McDonald memo has limited details, it breaks down four other specific categories of fraud that the division will seek to prosecute.

California’s new emergency hospice regulations: key requirements for providers JD Supra; by Margia Corner, Elicia Grilley Green, Lena Zinner; 8/13/26 For the first time in California’s history, hospice agencies have become subject to comprehensive hospice-specific licensing regulations adopted on an emergency basis and effective June 22, 2026. ... The new regulations apply to both existing licensees and new applicants, add significant new requirements for CDPH approval of transactions and other operational changes, such as the licensee’s physical location, and authorize CDPH to conduct unannounced inspections to verify compliance. Providers would benefit from reviewing their operations against the new requirements below.

New York clarifies Medicaid moratorium and ownership changesJD Supra; by Abygail Hoey, Max Lubin, Joseph Parise, Steven Schnelle; 8/11/26 Following the publication of McDermott Will & Schulte’s August 4, 2026, client alert, the New York State Department of Health (DOH) announced that it had received approval from the Centers for Medicare & Medicaid Services (CMS) to implement a plan (the DOH Medicaid Plan) to revamp New York’s Medicaid provider enrollment and revalidation processes in order to improve oversight of the New York Medicaid program. The DOH Medicaid Plan contains information regarding, among other things, new risk designations for certain types of providers, a new Medicaid revalidation process, and the moratorium on Medicaid enrollment for certain types of providers.

How California’s hospice industry spiraled out of control — and cost millions in fraud Los Angeles Daily News, Los Angeles, CA; by Jason Henry; 8/9/26 A quiet change in California law in 2018 unleashed a deluge of new hospices and spurred millions of dollars in Medicare fraud that state and federal authorities are still trying to unwind. ... It all started with three paragraphs added, at the request of the California Department of Public Health, to the end of an omnibus bill in 2018. CDPH had a backlog of 72 applications for hospice licenses at the time and wanted legislators to provide an alternative to a major bottleneck: its own inspectors. Under SB 1495, hospices could choose to pay a third-party accrediting organization for the inspection needed for a license, instead of waiting weeks or months for the next available state employee. ... Unlike a restaurant, which must undergo fire, building and health inspections, the vast majority of hospices in California could suddenly obtain a license, and even approval to bill Medicare, without a public employee stepping foot on the property. ...

Sixth Circuit clarifies Medicare safe harbor for hospice providers in landmark coverage decision JD Supra; by Jason Bring and Bill Dombi; 8/5/26 Key Takeaways

Hospice Coalition Questions and Answers: June 25, 2026Palmetto GBA; 8/4/26Includes Coalition questions, Hospice Appeals Reports, and Hospice CAP Updates.

Who worked with Brian Rowan? Sales representatives and medical providers allegedly joined nationwide wound-graft networkBefore It's News, Phoenix, AZ; 8/4/26 Prosecutors describe Alexandra Gehrke, Jeffrey King, affiliated medical businesses, unnamed sales representatives, and healthcare providers as participants within an alleged kickback-driven network targeting elderly and terminally ill patients across the United States. ... Hospice enrollment does not make advanced wound care automatically inappropriate because terminally ill patients can require interventions reducing pain, drainage, infection, odor, exposed tissue, or other symptoms affecting comfort and dignity. Prosecutors nevertheless allege that representatives deliberately visited hospice facilities because elderly beneficiaries with insurance coverage and persistent wounds offered continuing opportunities for expensive applications, even when meaningful healing remained clinically improbable.

Northern District of Texas charges 13 health care fraudsters for loss over $360 million United States Attorney's Office - Northern District of Texas; Press Release; 6/23/26 Catherine Nkeiru Maduka, 66, of Garland, Texas, was charged by indictment with conspiracy to commit health care fraud and health care fraud in connection with a hospice scheme, which resulted in over $3.1 million in false claims being submitted to Medicare. As alleged in the indictment, Maduka, the owner and CEO of Saint Catherine’s Hospice, recruited patients who were ineligible for hospice care and billed Medicare for services that were never provided.

Las Vegas Hospice booted from Medicare over ties to sanctioned provider Hoodline; by Christopher Kim; 7/29/26 OneCare Hospice, LLC has been kicked out of Medicare after a federal administrative law judge upheld a government move to cut off the Las Vegas company, not because its own claims were found fraudulent, but because of its legal ties to another Nevada hospice that had already lost its billing privileges. On top of the revocation, OneCare is staring at a 10-year Medicare reenrollment bar and a spot on the Centers for Medicare & Medicaid Services’ Medicare preclusion list. The decision, issued July 9 after OneCare appealed the earlier agency action, found that federal officials were within their rights to pull OneCare’s enrollment.

Physicians: proposed California rule threatens livelihood, providersHospice News; by Jim Parker; 7/28/26Some hospice medical directors contend that proposed emergency regulations in California represent a threat to their livelihood, as well as creating access risks for patients. The California Department of Public Health (CDPH) proposed the rules in June in an effort to combat fraud. Within the 143-page document, the sticking point for physicians is a requirement that, if finalized, would limit hospice medical directors to serving only one hospice. CDPH recently held an online stakeholder meeting regarding the proposal in which several physicians called on the agency to allow medical directors to serve as many as three hospices, or to eliminate the limitation altogether for at least some doctors.

Local nurse goes to Washington DC to meet with elected officials about hospice fraud YubaNet.com, Grass Valley, CA; by Foothills Compassionate Care; 7/22/26 Last month, at end of June, Registered Nurse, Kellie Bolle of Foothills Compassionate Care, traveled to Washington DC to meet with elected officials on the issue of fraud, waste and abuse in hospice care. ... With a rapidly escalating fraud crisis in hospice care, reputable, mission-focused organizations and providers are having to answer for a growing number of bad actors. Foothills Compassionate Care invites the public to an interactive town hall that will include: An update on national efforts to combat hospice fraud, insights from Clinical Care Manager Kellie Bolle, MSN, RN, CHPN, following her advocacy meetings in Washington, D.C., information about how to identify a reputable hospice provider, a discussion of hospice, palliative care, and the Medicare hospice benefit, and an open question-and-answer session with hospice professionals. Free and open to the public. [On Wednesday, July 29, 2026. Go to this article for their RSVP to the public.]

HHS pausing $1 billion in Medicaid payments to California, Minnesota over fraud LI; by Mary Chastain; 7/21/26 The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have paused more than $1 billion in Medicaid payments to California and Minnesota due to fraud concerns. “That includes more than $887 million for California and over $200 million for Minnesota,” HHS Secretary Robert F. Kennedy Jr. said at a press conference. “If those states want that money, they need to provide documentation that these payments are legitimate.”

MedPAC releases 2026 Medicare Data Book MedPAC - Advising the Congress on Medicare Issues; 7/16/26 The Medicare Payment Advisory Commission (MedPAC) released its 2026 data book on health care spending and the Medicare program. The publication provides data on Medicare spending, demographics of the Medicare population, beneficiaries' access to care, and quality of care in the program, among other information. You may go to the data book page on our website (www.medpac.gov) to view the data book and Excel data files.