Literature Review

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

Additional CMS website information for the Hospice Wage Index Final RuleCMS 

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.

Steps Medicaid plans can take now to prepare for Final CMS Community Engagement (Work) Requirement Rules Healthcare Business Today; by Luke Henderson; 7/25/26 Here’s the question on the mind of almost every Medicaid plan leader: Will our organization be ready once community engagement (work) requirements become mandatory? The answer could determine whether that plan succeeds or fails in the next few years. ... CMS’s Latest Guidance on Work Requirements, Explained ... The IFC specifies that work requirements will apply to non-pregnant, non-Medicare adults ages 19-64 who are enrolled in an Affordable Care Act (ACA) Medicaid expansion group or subject to certain Section 1115 demonstration waivers that provide minimum essential coverage to adult beneficiaries.Beneficiaries falling into these categories must demonstrate at least 80 hours per month of qualifying activities, which can include work programs, community service or at least half-time enrollment in an educational program. Individuals may combine activities to meet the mandates or earn the equivalent of 80 times the Federal hourly minimum wage ($580/month).

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.”

California physician arrested in $3.2m hospice fraud scheme Hospice News; by Holly Vossel; 7/17/26 A California-based physician was recently arrested after pleading guilty to charges of healthcare fraud. Dr. Sanjoy Banerjee, was a medical director for Fountain Hospice, based in Los Angeles. Two other medical directors at the hospice, Luis Artavia and Mark Samonte, also face charges for their alleged involvement in a fraud scheme that bilked more than $3.2 million in Medicare and Medi-Cal funds. The case centers around violations of false or fraudulent claims and conspiracy to commit a crime, with an aggravated white-collar enhancement.

Crushing and flexing: CMS proposes to expand its discretion to deny and revoke Medicare enrollment The National Law Review; by Karen S. Lovitch, Jane Haviland, Mintz; 7/14/26 ... Currently, CMS’s revocation authority allows it to revoke enrollment prospectively following notice to the Provider. Following revocation, the Provider is no longer allowed to bill Medicare. CMS’s proposal would not only make the revocation date retroactive to the date of alleged noncompliance (or other triggering event) but would also allow CMS to claw back payments to the retroactive revocation date. CMS estimates approximately $82 million in annual savings from this proposal, clearly indicating that CMS views it as a high-impact program integrity measure. CMS’s proposal is also notable because, if finalized, it would give CMS greater flexibility to address suspected fraud without considering criteria that might otherwise constrain its actions. For example: ...