Literature Review

Vohra Wound Physicians and its owner agree to pay $45M to settle fraud allegations of overbilling for wound care servicesDepartment of Justice press release; 11/21/25Dr. Ameet Vohra and his companies, including Vohra Wound Physicians Management LLC (Vohra), have agreed to pay $45 million to resolve allegations that they violated the False Claims Act by knowingly causing the submission of claims to Medicare for medically unnecessary surgical procedures, for more lucrative surgical procedures when only routine non-surgical wound management had been done, and for evaluation and management services that were not billable under Medicare coverage and coding rules... “Billing Medicare for medically unnecessary procedures and manipulating documentation to maximize profits not only defrauds taxpayers — it puts vulnerable patients at risk,” said Deputy Inspector General for Investigations Christian J. Schrank at the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG).Publisher's note: While these allegations specifically occurred in nursing homes and skilled nursing facilities, similar practices have occurred in hospice.

He built a nursing home empire despite state investigations. Now, lawsuits are piling upCal Matters; by Jocelyn Wiener; 11/20/25California nursing homes affiliated with Shlomo Rechnitz are facing lawsuits alleging that patients were raped, ignored and unnecessarily exposed to COVID-19. His companies deny the allegations. In February 2024, a Los Angeles County jury awarded $2.34 million to an 84-year-old nursing home resident named Betsy Jentz, finding that the facility had violated her rights on 132 occasions, at times leading to serious injuries. [Three more equally offensive cases.] All of these facilities have one thing in common: state records list Shlomo Rechnitz as an owner. Court documents show Rechnitz and his companies have denied all allegations in all of the cases.

Three Palmetto GBA ReportsPalmetto press release; 11/21/25

Hospice: Track errors, payment caps to avoid facing costly penalties Home Health Line, DecisionHealth; by MaryKent Wolff; 11/13/25 Keep a close eye on possible claim and billing mistakes that could lead to issues related to your payment cap. While increased revenue may seem like a good thing for providers, overpayments could lead to heightened scrutiny and financial hardships for your agency. [May require subscription for additional information]

7 women now charged in $100M Fort Bend hospice fraud scheme Houston Chronicle, Houston, TX; by John Wayne Ferguson; 11/3/25 Four more people have been charged in connection with a Fort Bend County Medicare scam, meaning seven are now accused of stealing tens of millions of dollars from the government by charging the health care fund for hospice care for patients who weren't actually dying. Hattie Banks, Lydia Obere, Cheryl Brooks and Ena Cowart were indicted by a federal grand jury on Oct. 8. All four were charged with healthcare fraud and two felony conspiracy charges related to the fraud and a plan to receive kickbacks. Banks, Obere and Brooks were also accused of receiving kickbacks.

CMS’s Special Focus Facility Program for Nursing Homes has not yielded lasting improvementsOIG press release; 10/29/25This report evaluated the effectiveness of the Centers for Medicare & Medicaid Services’ (CMS) Special Focus Facility (SFF) program, the agency’s flagship effort to address quality problems at the nation’s poorest-performing nursing homes. OIG found nearly two-thirds of facilities that graduated from the SFF program between 2013 and 2022 later exhibited recurring quality issues. Among nursing homes that received a serious deficiency in the three years after graduating, 38% put residents at risk of serious injury, harm, impairment or death. For program improvement, OIG recommended that CMS use more nonfinancial remedies, assess enforcement effectiveness—especially for staffing deficiencies—and incorporate ownership data.Publisher's note: It's interesting to see what works - and what doesn't work - from the CMS / OIG perspective.

Survey update during government shutdown - REVISED Guidance, 10/21/2025CHAP blog; 10/21/25CMS posted and update to the memo, Contingency Plans – State Survey & Certification Activities in the Event of Federal Government Shutdown (QSO- 26-01-ALL-Revised) on 10/21/2025 that provides updates to state survey activity during the ongoing federal government shutdown. The revised guidance appears in red text. CMS has instructed CHAP that our survey activity is unaffected, and we will conduct our survey accreditation business as usual.

Rural Health Transformation Program must consider care at home, Alliance tells CMS McKnights Home Care; by Adam Healy; 10/17/25 As stakeholders compete for funding from the Rural Health Transformation Program, the Centers for Medicare & Medicaid Services’ $50 billion rural healthcare grant initiative, home care providers are asking for their cut. “The RHTP represents a chance to reshape rural health systems around a continuum of care that extends beyond hospital walls,” Steve Landers, MD, chief executive officer of the National Alliance for Care at Home, said Wednesday in a letter to CMS. “The National Alliance for Care at Home strongly urges CMS to view home-based care not as an adjunct, but as an essential partner in the transformation of rural health delivery.”

The government shutdown’s impact on Medicare Advantage: As clear as mud? JD Supra; by Jeffrey Davis and Lynn Nonnemaker; 10/16/25 Over the last couple of weeks, stakeholders have raised many questions about how the government shutdown will affect different healthcare initiatives and programs, and Medicare Advantage (MA) is no exception. The Centers for Medicare & Medicaid Services (CMS) has provided guidance related to Medicare claims processing, telehealth services, and other operations, but most of that has pertained to Medicare fee-for-service (traditional Medicare). MA plans have been largely responsible for figuring out how the information applies to them. About half of Medicare beneficiaries are in MA, meaning more than 35 million Medicare beneficiaries and the providers who care for them rely on MA plans to communicate how benefits and coverage have, or have not, changed. As the shutdown drags on, CMS’s work to establish future MA policies and payment rates through rulemaking and notices also could be impeded. To discuss some of the ways that the shutdown has impacted MA and may continue to do so, I’m bringing in my colleague Lynn Nonnemaker. ...

Understanding parts of Medicare: A through N explained U.S. News & World Report / WTOP News; 10/14/25 The alphabet soup of Medicare — multiple parts and plans, starting with A all the way through N — can be bewildering, especially for those who are newly eligible for Medicare. In this guide, we break down each part of Medicare to help you find the best health insurance fit for your needs.

Hospice chain settles fraud claims for $3 million Law.com; 10/7/25 Guardian Hospice of Georgia and affiliated firms Guardian Home Care Holdings and AccentCare have agreed to pay $3 million to settle whistleblower claims that they submitted false claims to Medicare and Medicaid for hospice patients that were not terminally ill, the acting U.S. attorney in Atlanta announced Oct. 2.

The CMS activities that will, won’t continue during the shutdown Becker's Hospital Review; by Andrew Cass; 10/2/25 CMS has outlined the activities that will and won’t continue during the federal government shutdown. The federal government shut down at 12:01 a.m. Oct. 1 after lawmakers failed to reach a spending deal. CMS is retaining 53% of its staff, 3,311 employees, during the shutdown. Here is what the agency said will and won’t continue during a lapse in appropriations: ... Editor's Note: While this article is for the broader healthcare community, we posted extensive hospice-specific information for you in yesterday's issue, Government shutdown impact on telehealth for hospice and palliative care providers, by Judi Lund Person. Click here to download her complete PDF report.  

Let's face (to face) it: Important changes to hospice face-to-face attestation requirements and other tidbits from the 2026 Hospice Final Rule Husch Blackwell; podcast by Meg Pekarske; 9/24/25 ... All in all, the news is positive: while there is a new requirement for the F2F attestation to be signed and dated, the signed and dated F2F clinical note on its own can now serve as the F2F attestation. In this episode, Husch Blackwell attorneys Meg Pekarske and Andrew Brenton share their thoughts on what the updated F2F attestation rules mean for hospice operators and weigh in on other components of the final rule, including CMS’s attempt at housekeeping by clarifying the types of hospice physicians who can certify patients.