Literature Review

DOJ prioritizes hospice, home health fraud enforcement Hospice News; by MK Manoylov; 8/26/26 The U.S. Department of Justice (DOJ) Fraud Division has designated home health and hospice as among its top enforcement priorities. The agency plans to use innovative data analysis to target fraud schemes in these industries, according to a Thursday memorandum. The agency plans to further crack down on healthcare fraud by increasing the headcount of its Health Care Fraud Strike Force model to about 500 attorneys and staff by Aug. 24.

The Department of Justice's National Fraud Enforcement Division: a new era of coordinated fraud prosecution and what it means for corporate America Epstein Becker Green | Health Law Advisor; by Leah Brownlee Taylor, Erica Sibley Bahnsen, Sarah M. Hall, Andrew Beshai, Alkida Kacani, Gianna Costello; 8/21/26 On August 13, 2026, the Assistant Attorney General for the U.S. Department of Justice (“DOJ”) National Fraud Enforcement Division (the “NFED”), Colin M. McDonald, released a memorandum outlining NFED’s enforcement priorities. The memorandum is the first memo of this kind from NFED. The establishment of NFED earlier this year represented a watershed moment for federal fraud prosecution, as it established DOJ’s first-ever division dedicated exclusively to combating fraud against taxpayer dollars and taxpayer-funded programs. With a stated goal of having 500 prosecutors and staff by August 24, NFED seeks to deploy “cutting-edge data analysis” across a “whole-of-government” effort. The establishment of NFED signals a fundamental shift in federal fraud enforcement, ... The NFED memo identifies five priority areas for federal fraud prosecution:

Finding Medicare Fee-for-Service (FFS) Payment System Rules: schedules and resources Congressional Research Service - Informing the legislative debate since 1914; by Congressional Research Service, summary by Michele L. Malloy; updated 8/14/26 The Medicare Fee-for-Service (FFS) program pays physicians, hospitals, and other health care facilities based on statutorily established payment systems, most of which are updated annually through regulations. The publication of Medicare FFS proposed and final rules follow schedules based on requirements found in statute, regulation, or both. ... This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the payment systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued proposed rules, public comments, final rules, and subsequent corrections.

Hospice Wage Index, the Final Rule, and the signals CMS is sending | part one Teleios Collaborative Network (TCN); pocast hosted by Chris Comeaux with Annette Kiser and Judi Lund Person The 2027 Hospice Final Rule is more than a reimbursement update—it’s a window into where Centers for Medicare & Medicaid Services (CMS) believes hospice care needs to go next. In Part One, host Chris Comeaux sits down with hospice regulatory experts Annette Kiser and Judi Lund Person to look beyond the numbers and “read the tea leaves” in CMS’s latest rule.  They unpack what hospice leaders need to understand about the Hospice Election Statement Addendum, the growing scrutiny of unrelated services and non-hospice Medicare spending, telehealth reporting, and the Service and Spending Variation Index (SSVI).  As Judi explains, CMS’s commentary and responses to industry feedback can reveal as much about the agency’s direction as the regulations themselves.

Hospice Wage Index, the Final Rule, and the signals CMS is sending | part one Teleios Collaborative Network (TCN); pocast hosted by Chris Comeaux with Annette Kiser and Judi Lund Person The 2027 Hospice Final Rule is more than a reimbursement update—it’s a window into where Centers for Medicare & Medicaid Services (CMS) believes hospice care needs to go next. In Part One, host Chris Comeaux sits down with hospice regulatory experts Annette Kiser and Judi Lund Person to look beyond the numbers and “read the tea leaves” in CMS’s latest rule.  They unpack what hospice leaders need to understand about the Hospice Election Statement Addendum, the growing scrutiny of unrelated services and non-hospice Medicare spending, telehealth reporting, and the Service and Spending Variation Index (SSVI).  As Judi explains, CMS’s commentary and responses to industry feedback can reveal as much about the agency’s direction as the regulations themselves.

When a hospice patient comes to the hospitalICD10monitor; by Tiffany Ferguson, LMSW, CMAC, ACM; 8/17/26 A recent question was posed related to “What happens when a hospice enrolled patient returns to the hospital for emergency or hospital care?” Aside from the initial questions such as “did we even know this patient was on hospice when they roll through the emergency room, or why did they come back to the hospital? The next question may evolve to the following: is the treatment still involving care congruent with the patient’s hospice care plan or has the patient/representative elected to revoke their hospice services? Understanding these distinctions is increasingly important for case management, utilization review, registration, revenue cycle, and especially hospital clinical teams.

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.