Literature Review

O&I Subcommittee holds hearing with state Medicaid directors as part of committee’s extensive probe into Medicaid programs nationwide U.S. Energy & Commerce, Chairman Brett Guthrie, Washington, DC; Press Release; 6/25/26 [On Thursday June 25th], Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, led a hearing titled State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies. “Let me be clear: fraud is not isolated to these states. As we discussed in two previous hearings before this Subcommittee, Medicaid fraud is a real problem. It happens in every single state, red and blue, and has been harming patients and draining taxpayer resources for decades,” said Chairman Joyce. “It is no longer sufficient to do the bare minimum. States must rise to the occasion and tackle fraud head-on. Our Medicaid program and the patients that rely on it to be healthy depend on it.”Watch the full hearing here.

Hundreds including Iowans implicated in $6.5B health care fraud schemes Ames Tribune, Des Moines, IO; by Natalie Neysa Alund and William Morris, USA TODAY; 6/25/26 Hundreds of people and organizations, including several in Iowa, have been charged in connection with global health care fraud schemes totaling a record $6.5 billion, the U.S. Department of Justice says. ... Three of the cases were in Iowa. The largest involves Mercy Health Network, Genesis Health System and Trinity Health Corp., which operate the MercyOne Genesis system based in Davenport. According to the news release, the partners self-reported overuse and overbilling for a specialty heart pump from 2016 to 2022, and agreed to pay more than $4.6 million to the government. ... And prosecutors are criminally charging Jacob Hughes of Cedar Rapids and Hughes Home Care, which did business as Synergy Homecare.

Federal investigation into Medicare fraud snares Corona man Patch, Los Angeles, CA; by Toni McAllister; 6/23/26 Abraham Shin, 66, and two other people are charged in a 16-count indictment alleging they conspired to defraud Medicare out of $27 million. ...  According to the indictment, from February 2021 to March 2026, Oren David Shachar, 59, of Van Nuys — who owned and operated at least four hospice care companies — conspired with marketers Shin, and Jeannie Choi, 57, of Torrance. As part of the alleged fraudulent operation, claims for hospice services were submitted to Medicare that were medically unnecessary because the beneficiaries were not terminally ill, or the services were not provided because the beneficiaries were already dead, according to the indictment.

DOJ uncovers $6.5 billion healthcare fraud and charges record 455 defendants Washington Examiner; podcast by Kaelan Deese; 6/23/26 A nationwide healthcare fraud crackdown resulted in charges against 455 defendants accused of schemes involving more than $6.5 billion in fraudulent claims, marking what federal officials on Tuesday described as the largest coordinated healthcare fraud enforcement action in Justice Department history. Acting Attorney General Todd Blanche, Health and Human Services Secretary Robert F. Kennedy Jr., FBI Director Kash Patel, and Centers for Medicare & Medicaid Services Administrator Mehmet Oz announced the operation, which spanned 57 federal districts across 41 states and territories and included charges against 90 licensed medical professionals.

CMS recalculates MA star ratings payments in wake of Clover lawsuit Becker's Payer Issues; by Elizabeth Casolo; 6/18/26 CMS is “voluntarily recalculating” 2027 Medicare Advantage quality bonus payment ratings, based on 2026 star ratings, following Clover Health’s successful challenge of the agency’s measures. CMS sent a letter informing health plans June 17. In its reevaluation, CMS will only change a rating if a contract receives a higher quality bonus payment rating than before. The agency removed all Part D and some Part C measures in its review: special needs plan care management, health plan complaints, members choosing to leave, timely appeals decisions, appeals decision reviews, and call center availability of foreign language interpreters and teletypewriters.

CHAP: CMS posts Accrediting Organizations (AOs) Oversight Final Rule with Comment Community Health Accreditation Partner; Press Release; 6/16/26 Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions was posted on the Federal Register Public Inspection desk on 6/12/2026 and is estimated to post in the Federal Register on June 16, 2026. The Centers for Medicare and Medicaid Services (CMS) will accept comments related to the proposed rule through August 15, 2026, 11:59 pm. Information about submitting comments appears at the beginning of the rule. This final rule is effective June 16, 2027.

Vance’s fraud task force is sweeping up legitimate small businesses The Washington Post, Washington, DC; by Isaac Arnsdorf; 6/15/26 The vice president and other officials have downplayed evidence of collateral damage in their crackdown on fraudulent hospices. In April, when the Trump administration began suspending about 800 hospices in the Los Angeles area suspected of fraud, a small local agency started accepting patients from the affected providers. The owner never thought he would be next. ... “The Trump administration is taking a pretty aggressive tactic here, but the downside is you’re often going to catch up legitimate actors because you’re not really taking the time to do your due diligence,” said Hillary Loeffler, vice president of policy and regulatory affairs for the National Alliance for Care at Home, an industry group, who worked on hospice issues at CMS until 2025.

CMS home health and hospice moratoria update: emerging guidance and enforcement update JD Supra; by Christina Bergeron, Lauren Biggs, Robin Briendel; 6/10/26 This Alert discusses [developments since the May 13th CMS home health and hospice moratoria], as well as related state Medicaid and licensure activity, increasing enforcement activity, and recent federal legislative developments affecting the hospice and HHA sectors.

AHA comments on CMS’ FY 2027 LTCH Prospective Payment System Proposed Rule American Hospital Association; letter from Ashley Thompson, AHA Sr VP Public Policy Analysis and Development to Dr. Mehmet Oz, CMS Administrator; 6/8/26 On behalf of our nearly 5,000 member hospitals, health systems and other healthcare organizations, including approximately 230 long-term care hospitals (LTCHs); our clinician partners — more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 healthcare leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS’) fiscal year (FY) 2027 LTCH prospective payment system (PPS) proposed rule. ... Our detailed comments follow.

Los Angeles County Fraud Hotline LACounty.gov | Department of Auditor-Controller, Office of County Investigations; 6/8/26 You may remain anonymous, but having the ability to contact the informant is often critical to the success of an investigation. If you choose to provide your name and contact information, the County will hold your identity in confidence to the extent allowed by law. You can read more about this here.

Nevada Health Authority announces pause on new state licenses for hospice, home-health services as officials investigate possible Medicaid fraud KLAS, Las Vegas; by Linsey Lewis; 6/5/26 The Nevada Health Authority announced a temporary pause on new state licenses for hospice and home-health services as state officials conduct “extensive” reviews of all Medicaid-enrolled hospice and home-health providers to identify cases of fraud. The pause on new state licenses for hospice and home-health providers and a moratorium on new enrollments for Nevada Medicaid come as fraud in the hospice and home-healthcare spaces garners national attention with high-dollar crimes from Medicaid and Medicare billing activities and fake operations.

Medicare warns seniors of fraudulent offers for "free" medical equipment and hospice servicesWBIW.com, Indiana; 6/3/26 Federal health officials are urging older Americans to stay vigilant against a surge in healthcare scams targeting Medicare beneficiaries with promises of "free" medical supplies and services. ...

Dr. Joan Teno exposes the hidden problems with hospice ratings and quality scores | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Joan Teno; 6/3/26 What if the hospice ratings patients and families rely on don’t tell the full story?   In Part One of this thought-provoking conversation, renowned hospice researcher and policy expert Dr. Joan Teno joins Chris Comeaux and Cordt Kassner to unpack the hidden flaws within today’s hospice quality measurement systems. Drawing on more than 30 years of experience shaping hospice and palliative care policy, Dr. Teno explains why many publicly reported quality measures may fail to capture the true experiences of patients and families.  She discusses the challenges of transparency, the unintended consequences of current reporting systems, concerns about fraud and oversight, and how artificial intelligence could help transform the future of hospice quality measurement.