Literature Review
All posts tagged with “Regulatory News.”
Ohio toughens Medicaid fraud prevention with new initiatives
06/02/26 at 03:00 AMOhio toughens Medicaid fraud prevention with new initiatives Epstein Becker Green Law; by Ann Parks; 5/29/26 On May 13, 2026, Ohio Governor Mike DeWine announced new Medicaid fraud prevention initiatives focusing on home health and hospice providers from the Ohio Department of Medicaid (ODM). Governor DeWine also issued an Executive Order on May 18, 2026, directing new emergency rules for multiple provider enrollment enforcement actions including revalidations of identified high-risk providers.
CMS myth vs. fact: what hospice and home health providers need to know about the new Medicare enrollment moratoria
06/01/26 at 03:10 AMCMS myth vs. fact: what hospice and home health providers need to know about the new Medicare enrollment moratoria JD Supra; by Stephen Angelette, Mary Canavan, Simran Nijjar, Ross Sallade, Elizabeth Tucker, and Deja Williams; 5/26/26 [Responding to the CMS nationwide six-month moratoria barring new Medicare enrollments for hospice and home health agencies (HHAs), effective May 13 ... ] Any actions that trigger an initial Medicare enrollment are prohibited during the moratoria. This can include changes in ownership, new practice locations, additions of provider types, or other transactions requiring a new enrollment application.In this alert, we address common myths surrounding the moratoria and key considerations for providers during the six-month period. Guest Editor's Note, Judi Lund Person: Review this guidance for application to your hospice or home health planning, including mergers, acquisitions, and establishment of new practice locations or new branches.
CMS relaunching Hospice PEPPER Report in June 2026
06/01/26 at 03:00 AMCMS relaunching Hospice PEPPER Report in June 2026 LeadingAge; by Katy Barnett; 5/27/26 The Centers for Medicare and Medicaid temporarily paused PEPPER reports in January 2024, but over the last several months, the agency has released updated reports for other Medicare provider settings, such as critical access hospitals and short-term acute care hospitals.
CMS enrollment moratoria: CHOW implications for home health and hospice transactions
05/27/26 at 03:00 AMCMS enrollment moratoria: CHOW implications for home health and hospice transactions JD Supra; by Arnall Golden Gregory LLP; 5/22/26 ... Although the announcement has significant implications for new HHA and hospice entrants, the practical impact on change of ownership (“CHOW”) transactions is narrower: the moratoria should affect only those CHOWs that are treated as new initial enrollment under the Medicare “36-month rule.” ...Key Takeaways
CMS targeting Georgia, Ohio in fraud fight
05/26/26 at 03:00 AMCMS targeting Georgia, Ohio in fraud fight Hospice News; by Jim Parker; 5/22/26 Ohio and Georgia are seeing a large influx of new hospice operators, leading some to suspect that fraud is becoming more prevalent in those states. The four states that historically have been hotbeds for fraud — California, Arizona, Nevada and Texas — also saw hosts of new providers enter their markets, many of which were malfeasant. Among other efforts to combat the ongoing fraud, the U.S. Centers for Medicare and Medicaid Services (CMS) in 2023 instituted a provisional period of enhanced oversight for those four states. That has now been extended into Georgia and Ohio, retroactive to Dec. 31, 2025.
GAO makes MedPAC appointments
05/26/26 at 03:00 AMGAO makes MedPAC appointments U.S. Government Accountability Office (GAO), Washington, DC; Press Release; 5/22/26 Orice W. Brown, Acting Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of the Chair, Vice Chair, and two new members to the Medicare Payment Advisory Commission (MedPAC). She also reappointed two current members. MedPAC advises Congress on payments to providers in Medicare’s traditional fee-for-service program and to health plans participating in the Medicare Advantage program. ...
CMS clarifies telehealth policy during enrollment moratorium
05/25/26 at 03:00 AMCMS clarifies telehealth policy during enrollment moratorium Hospice News; by Jim Parker; 5/21/26 Hospices will continue to be able to use telehealth for face-to-face recertifications during the hospice and home health enrollment moratorium, according to the U.S. Centers for Medicare & Medicaid Services’ (CMS). ... The federal statute stipulates that telehealth recertifications are not permitted in regions that are under an enrollment moratorium. This has raised some questions about how hospices can use telehealth for the next six months. “Perhaps the most troubling unintended consequence of a nationwide moratorium is its apparent impact on telehealth …” a trio of state associations said in a joint statement. “In rural communities and congested urban areas alike, this imposes severe and unnecessary burdens on the most vulnerable patients at the most vulnerable moments of their lives.”
Development of the revised CAHPS Hospice Survey
05/22/26 at 03:00 AMDevelopment of the revised CAHPS Hospice Survey Journal of Pain and Symptom Management; by Danielle Schlang, MA, Melissa A. Bradley, BA, and Rebecca Anhang Price, PhD; 5/18/26 ... Methods: We conducted a plain language review and environmental scan, refined existing survey instrument wording, drafted candidate survey items addressing new topics of interest, and conducted 7 rounds of cognitive interviews with a total of 59 family caregivers of hospice decedents. Results: Cognitive interview respondents consistently interpreted “respecting [the patient’s] wishes,” and “listening to the things that matter most” and found these concepts relevant to their family members’ hospice care experiences; in contrast, they found the phrases “cultural practices” and “choosing what to do next” confusing or unclear. ... Conclusion: The revised CAHPS Hospice Survey simultaneously adds new topics prioritized by stakeholders and reduces survey complexity and length. Editor's Note: This journal article includes a downloadable "Journal Pre-proof" PDF. Its Appendix B (at pp. 27-33) provides a helpful table, "Comparison between Original and Revised CAHPS Hospice Survey Items, with Rationale."
Background on CMS’s anti-fraud efforts in hospice care
05/22/26 at 02:00 AMBackground on CMS’s anti-fraud efforts in hospice careAEI - The American Enterprise Institute; by James C. Capretta; 5/21/26 ... For broader context, Congress added hospice coverage to Medicare in the 1980s to provide lower-cost and more patient-centered settings for terminally ill beneficiaries. ... Like home health, the hospice benefit is vulnerable to abuse because the barriers to entering the market are lower than in more regulated settings. The capital investment to get started is minimal in comparison with building a new hospital, outpatient clinic, or nursing home. Further, the potential profit margins are high if a service provider is confident that the per diem is above what is needed to provide the required services.Although CMS’s focus on fraud in hospice care is warranted, stronger oversight by itself may not produce large program savings. In theory, more use of hospice care could lead to lower overall costs if the sponsoring agencies are competent and can help their patients avoid costly hospital or nursing home admissions. CMS’s investigations need to be subtle enough to weed out the bad actors without making it overly difficult for vulnerable patients to get the care they need in their own homes or in other low-cost community settings.
Loving Hands Hospice challenges Medicare payment suspension, cites due process concerns amid California hospice enforcement actions
05/21/26 at 03:00 AMLoving Hands Hospice challenges Medicare payment suspension, cites due process concerns amid California hospice enforcement actions TMX Newsfile | Newsfile Corp., Los Angeles, CA; Press Release; 5/19/26 Loving Hands Hospice, a women-owned hospice care provider based in Los Angeles, California, has announced that it is currently involved in a legal dispute connected to Medicare payment suspension measures and related allegations under review (Reference Number: PSP-260330-00042). ... Loving Hands Hospice, which has provided hospice services to patients and families in the Los Angeles area for approximately five years, says it supports enforcement actions where legitimate fraud is identified. However, company leadership states that broad enforcement measures applied across California's hospice sector may not adequately account for differences in individual provider circumstances, patient populations, and compliance histories.
CMS’s nationwide moratorium on new hospice and home health enrollments: operational, transactional, and enforcement risks for existing providers, healthcare organizations, and investors
05/21/26 at 03:00 AMCMS’s nationwide moratorium on new hospice and home health enrollments: operational, transactional, and enforcement risks for existing providers, healthcare organizations, and investorsClark Hill; by Jose Vela Jr.; 5/19/26 ... Key Takeaway: The larger issue may no longer be whether fraud exists within isolated hospice or home health agencies. ... Healthcare organizations, investors, healthcare professionals, and operational leaders affiliated with hospice and home health providers may wish to evaluate ownership structures, pending transactions, enrollment status, billing practices, referral relationships, operational controls, reimbursement exposure, and existing government scrutiny before operational disruptions, payment suspensions, recoupment activity, or enforcement actions arise.
Hawai'i Attorney General rejects characterization of Medicaid fraud enforcement and defends state's enforcement record
05/19/26 at 03:00 AMHawai'i Attorney General rejects characterization of Medicaid fraud enforcement and defends state's enforcement record Hawai'i Free Press, Honolulu, HI; by News Release from Department of the Attorney General; 5/14/26The Department of the Attorney General today rejected recent claims that Hawaiʻi “isn’t taking Medicaid fraud seriously,” calling the claims by Vice President J.D. Vance false and unsupported by the record. Since 2021, the Medicaid Fraud Control Unit (MFCU) has secured or helped secure judgments, settlements and recoveries in 25 cases, totaling $14,094,547.91. Last year, the MFCU secured a $30,000 settlement against a Medicaid provider for fraudulent billing. Earlier this year, the MFCU secured another Medicaid fraud settlement in the amount of $208,317.69. The MFCU also filed criminal charges earlier this year against two individuals, one of whom has already pleaded no contest as charged. [Hawai'i Medicaid Fact Sheet] Editor's Note: This article references "Hawaii's Medicaid coverage for palliative care expected to save the state money," which describes, "Hawaii is the first state to include palliative care in its Medicaid plan."
Ohio taking new steps to target Medicaid fraud
05/18/26 at 03:00 AMOhio taking new steps to target Medicaid fraud Spectrum News 1, Cleveland and Columbus, OH; by Aliah Keller; 5/14/26Ohio is taking new steps to crack down on Medicaid fraud, with a focus on home-healthcare and hospice providers.What You Need To Know
CMS leader explains hospice fraud, Medicare risks, and the future of healthcare | part two
05/18/26 at 02:00 AMCMS leader explains hospice fraud, Medicare risks, and the future of healthcare | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Kim Brandt; 5/13/26 In this compelling first installment, CMS Chief Operating Officer and Deputy Administrator Kim Brandt joins Chris Comeaux for a candid conversation about the growing hospice fraud crisis, the financial future of Medicare, and the urgent transformation happening across American healthcare. Drawing from her leadership role at CMS and firsthand experiences with hospice care in her own family, Brandt shares why hospice remains a critical pillar of compassionate care — while also exposing the alarming abuse threatening the integrity of the system.
Hospice fraud is becoming a political flashpoint. Why?
05/14/26 at 03:00 AMHospice fraud is becoming a political flashpoint. Why? National Public Radio WAMU; by Michelle Harven; 5/11/26 The state of California recently charged 21 people with hospice fraud, accusing them of costing the state $267 million. These types of schemes start with criminals opening up shell companies, signing recipients up without their knowledge, and then billing Medi-Cal for nonexistent services. This can have a serious effect on a senior’s ability to find care in the future. And it’s not just a state matter. The push to uncover this kind of fraud has become a political battle ... We sit down and talk about why we’re seeing this kind of fraud happen, who it harms, and why it’s become a political flashpoint.
DOJ doubles down on healthcare fraud enforcement with new West Coast strike force
05/13/26 at 03:00 AMDOJ doubles down on healthcare fraud enforcement with new West Coast strike force MedCity News; by Katie Adams; 5/10/26 ... The DOJ rolled out a strike force targeting healthcare fraud in Arizona, Nevada and Northern California. The new strike force — which the DOJ is calling its “West Coast” healthcare fraud strike force — comes seven months after the department launched a similar strike force going after healthcare fraud in Massachusetts. Florida is not on this list yet, even though it has a reputation for healthcare fraud, but it might be next.
Local hospice leader exposes fraud draining millions in taxpayer dollars across Texas
05/12/26 at 03:00 AMLocal hospice leader exposes fraud draining millions in taxpayer dollars across Texas KWTX 10, Waco, TX; by Nicole Marino; 5/8/26 Texas hospice licenses have nearly doubled since 2020, with some operators billing Medicare for patients who don’t know they’re enrolled. ... Lisa McNair, president and CEO of Hospice Brazos Valley, testified before the Texas Senate Committee on Health and Human Services in April with research showing the number of hospices in Texas has nearly doubled since 2020. There are now more than 1,300 hospices operating in the state. ... McNair told KBTX that the fraud is draining taxpayer dollars and eroding trust in legitimate end-of-life care.
Healthcare leaders break down hospice reform, Medicare & quality care | part two
05/12/26 at 12:00 AMHealthcare leaders break down hospice reform, Medicare & quality care | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Tom Koutsoumpas and Carole Fisher; 5/6/26 In Part One of Healthcare Leaders Break Down Hospice Reform, Medicare & Quality Care, Chris Comeaux sits down with nationally respected healthcare leaders Tom Koutsoumpas, Founder & CEO of NPHI and Carole Fisher, President of NPHI to explore the evolving future of hospice, palliative care, Medicare oversight, and the growing demand for quality-driven, compassionate healthcare leadership. Together, they unpack the growing challenges facing end-of-life care — from fraud and benefit manipulation to the urgent need for quality transparency and authentic patient-centered care.
CMS trains its program integrity sights on Texas Hospices
05/07/26 at 03:00 AMCMS trains its program integrity sights on Texas Hospices JD Supra; by B. Scott McBride and Howard Young; 5/5/26 California has seen hundreds of hospice “takedowns” and Medicare payment suspensions targeting what the Centers for Medicare & Medicaid Services (CMS) proclaims are a multitude of fraudulent hospices, particularly in LA County. Now, based on recent public statements of CMS Administrator Dr. Mehmet Oz, it appears CMS is poised to train its sights on fraud, waste, and abuse among Texas hospice agencies.
CMS enforcement activity – hospice termination notices
05/06/26 at 03:00 AMCMS enforcement activity – hospice termination notice CMS.gov - Public Notices; 5/1/26 CMS continues to post Medicare enrollment termination notices for hospices. The most recent posting on May 1, 2026 shows terminations for the last 14 months. Public Notices | CMS
MedPAC comment on CMS’s proposed rule on hospice for FY 2027
05/05/26 at 03:00 AMMedPAC comment on CMS’s proposed rule on hospice for FY 2027
CMS posts information on hospice election notification pilot: crushing fraud, waste, & abuse
05/05/26 at 03:00 AMCMS posts information on hospice election notification pilot: Crushing fraud, waste, & abuseCMS.gov; 5/1/26 On April 30, 2026, CMS announced that they had expanded the Hospice Election Notification pilot from Nevada into California. During the pilot, when a hospice provider files a Notice of Election, a notification letter is immediately sent to the beneficiary to make sure they know they have been enrolled in hospice. If they did not enroll, they are instructed to call 1-800-MEDICARE who can help with overturning the election. Since the start of the pilot in Nevada in May 2025, more than 25,000 letters have been issued. A copy of the letter being sent to beneficiaries in these states is available here.
Alliance sounds alarm over federal payment suspensions tactic to fight hospice fraud
05/04/26 at 03:00 AMAlliance sounds alarm over federal payment suspensions tactic to fight hospice fraud McKnights Home Care; by Liza Berger; 5/1/26 As the federal government continues to crack down on rampant hospice fraud in California and other states, advocates for the field fear that the government’s latest enforcement effort is unintentionally trapping ethical providers. ... While the government is basing a payment suspension on “a credible allegation of fraud,” the National Alliance for Care at Home worries that the government is using just one metric to justify its “credible allegation.” ... In a post this week, law firm Foley & Lardner LLP CMS defined a “’credible allegation of fraud’ as an allegation of fraud from any source, including but not limited to the following: (1) fraud hotline tips ... verified by further evidence; (2) claims data mining; and (3) patterns identified through provider audits, FCA cases and investigations.”
Hospice scammer receives 2-year prison sentence
05/01/26 at 03:00 AMHospice scammer receives 2-year prison sentence Hospice News; by Jim Parker; 4/20/26 Alex Alexsanian, 48, received a federal prison sentence for defrauding Medicare of more than $14 million for hospice services and diagnostic imaging that was never provided. Alexsanian also pleaded guilty in January to one count of conspiracy to commit money laundering. He was sentenced to two years and three months in federal prison and ordered to forfeit $3 million in proceeds from the scheme, according to the U.S. Attorney’s Office. He allegedly conspired to commit fraud with California hospice owner Sophia Shaklian, 38, who in March was sentenced to 35 months in federal prison and ordered to pay $14 million in restitution.
Kansas veteran dies in hospice weeks after KWCH story on cancer fight, push for health benefits
04/30/26 at 03:00 AMKansas veteran dies in hospice weeks after KWCH story on cancer fight, push for health benefits KWCH-12 News, Wichita, KS; by Matt Heilman and KWCH Staff; 4/28/26 A Kansas veteran whose story 12 News shared last month following the initial denial of her VA health benefits amid her cancer battle died Monday night in hospice care, her husband confirmed. Lorraina Robles, who served in the Air National Guard, most recently in Africa, fought stage 3 cervical cancer for over a year. Adding to the difficulty, her VA benefits for cancer treatment and other health benefits were denied following her return from deployment.
