Literature Review

CMS 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.

DOJ 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. 

Healthcare 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 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 

CMS 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.

Hospice 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. 

The Alliance and the Research Institute for Home Care Release Inaugural Medicaid Home Care Chartbook National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 4/27/26 The National Alliance for Care at Home (the Alliance) and the Research Institute for Home Care (the Institute) today released the 2026 Medicaid Home Care Chartbook, the first report of its kind providing a broad overview of the Medicaid Home and Community-Based Services (HCBS) user population, workforce, organizational trends, and economic contributions of Medicaid home care providers across the U.S. 

Arizona wound graft cases LundPerson & Associates Hospice Consulting - Enforcement Briefing; by Judi Lund Person; 4/23/26Hospice Patient Targeting - Detailed Case Card

New research shows earlier hospice election could save Medicare over $1 billion annually National Alliance for Care at Home, Alexandria, VA; Press Release; 4/23/26 A new analysis commissioned by the Research Institute for Home Care (the Institute) reveals that if Medicare beneficiaries elected hospice care just five days earlier, the program could save between $1.19 billion and $1.5 billion annually.  The analysis, conducted by ATI Advisory, demonstrates how modest, clinically appropriate changes in hospice timing could generate significant Medicare savings while improving patient outcomes. These findings are particularly relevant as Medicare spending on hospice services increases by nearly 10% annually, and overall enrollment of Medicare beneficiaries using hospice continues to grow.

Fraud migrating from hospice to home health, witness warns Congress Home Health Care News; by Morgan Gonzales; 4/21/26 Medicare fraud has shifted from hospice to home health in certain markets, according to testimony presented to the U.S. House of Representatives Ways & Means Committee on Tuesday. Sheila Clark, the president and CEO of the California Hospice & Palliative Care Association (CHAPCA), testified before the committee that the Centers for Medicare & Medicaid Services must take “aggressive action” to cull home health Medicare fraud. ... CHAPCA represents more than 250 hospice and home health provider members supporting more than 2,000 clinicians.

“This is the beginning”: DOJ signals intensifying health care fraud enforcement in California Pillsbury; by Christopher Lee, Dylan M. Aste, Fank Kalinski; 4/16/26 Recent U.S. Department of Justice (DOJ) and California Attorney General enforcement activity sends a clear signal that California health care entities that interact with government programs—in particular the hospice and home health industries—are now under intense scrutiny. Companies in these sectors should prepare for subpoenas, Civil Investigative Demands, and searches as a result of federal and state agencies conducting independent and parallel investigations. This uptick in government enforcement is sure to spur qui tam relators and whistleblowers. Unprepared California hospice and home health companies may face significant civil, and even criminal, exposure.

Hospice Insights Podcast - high risk hospices are in the hot seat across six states JD Supra; podcast by Husch Blackwell, LLP; 4/15/26 Since September 2024, CMS’s Medicare Administrative Contractors have been conducting expanded prepayment reviews (also known as “EPRs” or targeted high-risk reviews) of existing hospice providers in Arizona, California, Nevada, and Texas. As of December 2025, hospices in Georgia and Ohio are also under the microscope. In this episode, Husch Blackwell attorneys Bryan Nowicki and Zaina Niles discuss how hospices can differentiate between EPRs and other audit types. You’ll also learn what to expect throughout the EPR process and strategies to overcome claim denials and other possible EPR consequences.

Hospice fraud: the $530m surge and the new era of “zero tolerance”Lund Person & Associates Hospice Consulting; by Judi Lund Person; 4/16/26 The landscape for hospice care in the United States has shifted dramatically. As of April 15, 2026, federal and state enforcement data signals a pivotal moment: the “light-touch” era is officially over. With over $530 million in alleged losses tracked in the last 12 months, providers are now under the most intense scrutiny in the history of the Medicare hospice benefit.