Literature Review

HHS launches committee to shape Medicare, MedicaidBecker's Payer Issues; by Andrew Cass; 8/22/25HHS and CMS are establishing a panel of experts tasked with providing recommendations on how to “improve how care is financed and delivered” across Medicare, Medicaid, the Children’s Health Insurance Program and the ACA’s exchanges... “This committee will help us cut waste, reduce paperwork, expand preventive care, and modernize CMS programs with real-time data and accountability, all while keeping patients at the center,” Dr. Oz said in the release.Publisher's note: Click here for additional information or to apply to particiate on this Technical Expert Panel.

Navigating the Wage Index: Insights from industry experts Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Annette Kiser and Judi Lund Person; 8/20/25 The healthcare landscape is transforming before our eyes, shifting away from hospital-centered care toward home-based models.  This fundamental change raises urgent questions about Medicare's outdated reimbursement systems, particularly for Hospice providers facing a mere 2.6% rate increase while battling significant inflation. Join us in this illuminating conversation and in-depth discussion with industry experts Annette Kiser, Chief Compliance Officer with Teleios, and Judi Lund Person, Principal, Lund Person & Associates LLC, as they sit down with Chris and explore the complexities of the final 2026 Hospice Wage Index and its impact on Hospice organizations.

The Medicare Advantage, ACA and No Surprises Act lawsuits to watch Modern Healthcare; by Bridget Early; 8/18/25 Legal challenges to Medicare Advantage marketing, health insurance exchange regulations and the No Surprises Act are working their way through the courts with major implications for the healthcare sector. Here are some key cases that could change how health insurance companies sell Medicare plans, how insurers and providers resolve out-of-network billing disputes, how consumers sign up for health insurance exchange plans, and how preventive healthcare is covered. 

Merging clinical and legal: How home health providers achieve medical appeals success Home Health Care News; by Joyce Famakinwa; 7/31/25 For home-based care providers, medical appeals can be extremely costly. When navigating the medical appeals process, home health clinical and legal teams must operate in lockstep in order to achieve successful results and avoid financial blowback, ... ROI should be the biggest determining factor when deciding to appeal, according to Bill Dombi, senior counsel for Arnall Golden Gregory law firm. He formerly served as the president of the National Alliance for Care at Home. ... Despite the hefty costs that medical appeals can potentially rack up, sometimes figuring out the ROI can go beyond dollars and cents. For example, if a provider is going through the Medicare Targeted Probe and Educate (TPE) audit process.

Glendale woman sentenced to 9 years in federal prison for $10.6 million hospice fraud scheme involving kickbacks for patients United States Attorney's Office - Central District of California, Los Angeles, CA; Press Release; 8/5/25 A Glendale woman was sentenced today to 108 months in federal prison for participating in a scheme in which hundreds of thousands of dollars in illegal kickbacks were paid and received for patient referrals that resulted in the submission of approximately $10.6 million in fraudulent claims to Medicare for purported hospice care. Nita Almuete Paddit Palma, 75, of Glendale, was sentenced by United States District Judge Dolly M. Gee, who also ordered her to pay $8,270,032 in restitution. 

HHS sets its sights on $50b in cost savings: Medicare payments to nonhospice providers potentially under fire JD Supra; by Taylor Henderson, Callan Stein, Rebecca Younker; 7/31/25 In May 2025, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a review, titled " Potential Cost Savings HHS Programs – HHS Actions," which provided some insight into the OIG's direction to accomplish the Trump administration's stated goal of cutting federal spending. This review spans 35 reports, adding up to $50 billion in potential cost savings — including a reported $6.6 billion in potential savings by preventing Medicare payments for nonhospice items or services furnished to active hospice beneficiaries (nonhospice payments). When a beneficiary qualifies for and elects hospice benefits, the beneficiary signs a statement choosing hospice care over other Medicare-covered treatments for their terminal illness, and the hospice provider is paid a daily, per diem rate to provide these comprehensive services. With nonhospice payments accounting for a significant portion of HHS's potential savings, providers across the health care industry — including nursing and long-term care facilities, hospice and home health agencies, hospitals, individual providers, pharmacies, and medical equipment distributors — will need to be ready for the OIG's possible next steps.

Georgia may be next for enhanced hospice oversight, regulatory affairs expert predicts McKnights Home Care; by Adam Healy; 7/29/25 Warning, hospice providers in Georgia. Your state may be the next target for the Centers for Medicare & Medicaid Services’ Provisional Period of Enhanced Oversight (PPEO). “If you are from Georgia, do not be surprised if something like this comes to your town soon,” Katie Wehri, vice president of regulatory affairs, quality and compliance for the National Alliance for Care at Home, said on the closing day of the Alliance’s Financial Management Summit Tuesday. “The reason is that the Medicare Payment Advisory Commission and CMS have both mentioned Georgia as an area where there’s a high number of new hospices.” Four states are currently the subject of PPEO: California, Arizona, Nevada and Texas. California — and specifically Los Angeles County — has been a hotbed of hospice fraud in recent years. 

Hospice | CMS.gov/Fraud Fast FactsCMS.gov/Fraud; by CMS; July 2025 ... Medicare hospice utilization has increased in recent years. In Fiscal Year 2024, Medicare payments for hospice reached over $27 billion, with approximately 1.8 million Medicare beneficiaries receiving hospice care. CMS has taken significant action to address likely fraudulent behavior occurring in Medicare-enrolled hospices, including long lengths of stay, co-located hospices, and high rates of beneficiaries discharged alive. [This Fast Facts one-page sheet includes:]

Be on the lookout for this new Medicare scam Las Vegas Review-Journal; by Toni King; 7/24/25 Dear Toni: A hospice agent recently came knocking on the doors in my neighborhood saying he represented Medicare. He was giving away hospice gifts and told me that I could receive these Medicare services at no charge for me and my husband. I told him that I did not give out personal information to anyone that I do not know. Now, I’m concerned that I could have made a mistake. Should I call and ask if this Medicare service is still available? —Deidre, Katy, Texas Dear Deidre: Medicare is not giving away anything free! This is a new scam that is targeting America’s Medicare population.  ...Editor's Note: Though we’ve addressed this topic repeatedly in recent months, ongoing awareness and community education remain essential. Please continue seeking opportunities to collaborate with media outlets in your service areas to help inform and protect vulnerable populations. Use the following articles—previously featured in our newsletter—as reference points:

CMS plans hiring spree ahead of new payment models Becker's Hospital Review; by Alan Condon; 7/22/25 The CMS Innovation Center plans to hire a string of new employees as it plans to roll out several new payment models. The move comes four months after HHS, CMS’ parent department, cut about 5% of the agency’s workforce, Politico reported July 21. Four things to know:

Perform detail-oriented internal audits to avoid common denials DecisionHealth - Home Health Line; by MaryKent Wolff; 7/18/25 The most common reason for hospice denials in the first quarter of 2025 was that the claim was not hospice appropriate, according to Palmetto GBA, a Medicare Administrative Contractor (MAC) servicing 16 states. Palmetto released its list of the top 10 hospice medical review denial reasons from January to March 2025 on May 16. [Subscription required.]

AAPA asks CMS to remove regulatory restrictions on PAs providing hospice care American Academy of Physician Associates (AAPA); by Trevor Simon; 7/9/25 In June 2025, AAPA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the topics of hospice, skilled nursing facilities, inpatient rehabilitation facilities, and inpatient psychiatric facilities. These comments, in response to annually released proposed rules that make adjustments to the hospice wage index and respective fee schedules, responded directly to inquiries made within the rules, as well as identified policy obstacles faced by PAs in these settings. [Continue reading for] a brief summary of the topics AAPA discussed in each, with links to the full letters.