Literature Review

Home health advocates accuse CMS of overreach on fraud-fighting measures McKnights Home Care; by Liza Berger; 7/10/26 While there has been much focus so far on the continuing behavioral adjustments in the recent home health proposed rule, there is another aspect of the rule that has drawn providers’ scorn — the harsh fraud measures. “The rule proposes significant expanded authority for CMS to deny or revoke Medicare enrollment,” Jennifer Sheets, CEO of the National Alliance for Care at Home, said during a webinar hosted by the Polsinelli law firm Thursday. “These enrollment provisions are a particular concern for us.” Sheets pointed out to a provision in the program integrity proposals that would expand the reapplication bar — prohibiting a provider from re-enrolling for up to 10 years — for any enrollment denial reason. “This really concerns us,” she said. “We think it is overreach from CMS, and that 10-year bar is a pretty scary thing to be looking at.”

Hospice should offer dignity, not deception | Your turn VC Star, Ventura County, CA; by Molly Corbett; 7/11/26 Not long ago, a Ventura County family called Livingston for help. Their loved one was enrolled with another hospice but had not received a visit from one of its nurses in more than three weeks. Consider what those weeks must have felt like. The family had made one of the most difficult decisions it would ever face. Instead of focusing on their loved one, they were left wondering when help would come and whether anyone was paying attention. That’s the human cost of hospice fraud and neglect. It’s not only money improperly billed to Medicare. It’s pain that may go unmanaged, calls that go unanswered and precious time consumed by fear and frustration.

HIPAA Security Rule Amendments now projected For July 2027 - Healthcare - United States Mondaq | Holland & Knight Healthcare blog; by Dianne Bourgque; 7/7/26 The U.S. Office of Management and Budget has pushed back the final publication date for updates to the HIPAA Security Rule to July 2027, extending the timeline for proposed changes that would significantly strengthen data breach protections. The delay comes amid criticism from healthcare providers and stakeholders regarding the scope of modifications to the original rule, leaving the healthcare industry in uncertainty about how the current administration will address these concerns.Guest Editor's Note by Judi Lund Person: According to Reginfo.gov, the U.S. Office of Management and Budget's website for the federal regulatory process, the new Final Action Date – the projected publication date of the final Health Insurance Portability and Accountability Act (HIPAA) Security Rule – is July 2027. In January 2025, the U.S. Department of Health and Human Services' Office for Civil Rights (OCR) published a proposed rule to strengthen the HIPAA Security Rule. The proposal responded to substantial increases in large-scale data breaches – those affecting 500 or more individuals – reported to OCR between 2018 and 2023. Read more about the proposed rule.

CMS’ proposed Palliative Care Benefit: What we know so far CHAP - Community Health Accreditation Partner; free webinar to be presented by Dr. Jennifer Kennedy and Dr. Mary Lynn McPherson; to be presented 7/15/26 CMS recently released the FY 2027 Hospice proposed rule and the CY 2027 Home Health proposed rule, both of which address community-based palliative care. Join CHAP for a review of CMS's proposed changes, including new requests for feedback, clarification on the provision of skilled palliative care services under existing Medicare home health benefits, and planned future guidance on covered palliative care services. We'll also discuss how CMS distinguishes palliative care from hospice care and its role in supporting patients with serious illness who continue to receive life-prolonging treatment. 

Investigation revealing $6.5B in healthcare fraud signals more oversight of wound care Nurse.com; by Zelda Meeker; 7/6/26 ... Why skin substitutes have become a fraud target: The heightened focus surrounding wound care reflects a dramatic increase in Medicare spending on skin substitute products over the past several years. According to the HHS-OIG, Medicare Part B spending on skin substitutes grew from approximately $256 million in 2019 to more than $10 billion by the end of 2024. The OIG has warned that this rapid increase far outpaced expected utilization and identified significant vulnerabilities for fraud, waste, and abuse under the current reimbursement system. ... In terms of wound care fraud, alleged schemes have included:

Errors in billing in the United States may result in severe civil or even criminal penalties Spilman Thomas & Battle; by Christopher R. Arthur, William S. Thompson; 7/1/26 The United States Department of Justice (DOJ) has ratcheted up its efforts to pursue actions against corporations, healthcare entities, and individuals, including physicians, for false Medicare or Medicaid billing and COVID-19-related loans. ... As part of this announcement, the Centers for Medicare and Medicaid Services (CMS) suspended 1,079 providers and revoked billing privileges for 1,403 providers. ... In addition to allowing the United States to pursue perpetrators of fraud on its own, the FCA allows private citizens to file suits on behalf of the government (called “qui tam” suits) against those who have defrauded the government. In the healthcare realm, these suits are often filed by disgruntled employees and patients, but can also be brought by competitors. ...

Expose Hospice Los Angeles County fraud now—whistleblowers guide News Daily; by Simone Barbon; 7/3/26 Hospice Los Angeles County fraud cases have drawn national attention in 2026, and whistleblowers supplied the first usable evidence that turned audits into arrests. Their reports documented phantom patients, stolen identities, and providers billing Medi-Cal and Medicare for care never delivered. Recent enforcement actions show how those tips translated into criminal charges and committee hearings.

Scam alerts issued as fraudsters target Washington Parish residents The Bogalusa Daily News, Bogalusa, LA; by Kim Gerald; 6/26/26 Washington Parish residents are being urged to remain vigilant as several scams continue to circulate throughout the area, targeting individuals through phone calls, text messages and emails. Local authorities and healthcare providers have recently issued warnings about multiple fraud schemes designed to steal money and personal information from unsuspecting victims. One of the latest alerts comes from Riverside Medical Center, which is warning Medicare recipients about scammers offering free medical equipment or healthcare services. ... Officials caution that hospice scams can be especially damaging because victims may unknowingly be enrolled in hospice care, potentially affecting their access to regular Medicare benefits.

O&I Subcommittee holds hearing with state Medicaid directors as part of committee’s extensive probe into Medicaid programs nationwide U.S. Energy & Commerce, Chairman Brett Guthrie, Washington, DC; Press Release; 6/25/26 [On Thursday June 25th], Congressman John Joyce, M.D. (PA-13), Chairman of the Subcommittee on Oversight and Investigations, led a hearing titled State Medicaid Program Integrity: Examining Fraud Risks and Oversight Deficiencies. “Let me be clear: fraud is not isolated to these states. As we discussed in two previous hearings before this Subcommittee, Medicaid fraud is a real problem. It happens in every single state, red and blue, and has been harming patients and draining taxpayer resources for decades,” said Chairman Joyce. “It is no longer sufficient to do the bare minimum. States must rise to the occasion and tackle fraud head-on. Our Medicaid program and the patients that rely on it to be healthy depend on it.”Watch the full hearing here.

San Antonio woman indicted in $9 million federal Medicare scam WOAI-4 NBC, San Antonio, TX; by Amanda Moreno; 6/24/26 A San Antonio woman has been charged in a federal health care fraud case that involved millions of dollars in improper Medicare claims. Christina Charles, 52, is accused of taking illegal kickbacks in exchange for referring patients to several San Antonio-area hospice companies. According to federal prosecutors, those referrals led to more than $9 million in Medicare claims for hospice services that were not eligible for reimbursement because they were tied to kickbacks. Medicare ultimately paid about $3 million on those claims, according to the indictment.

Federal investigation into Medicare fraud snares Corona man Patch, Los Angeles, CA; by Toni McAllister; 6/23/26 Abraham Shin, 66, and two other people are charged in a 16-count indictment alleging they conspired to defraud Medicare out of $27 million. ...  According to the indictment, from February 2021 to March 2026, Oren David Shachar, 59, of Van Nuys — who owned and operated at least four hospice care companies — conspired with marketers Shin, and Jeannie Choi, 57, of Torrance. As part of the alleged fraudulent operation, claims for hospice services were submitted to Medicare that were medically unnecessary because the beneficiaries were not terminally ill, or the services were not provided because the beneficiaries were already dead, according to the indictment.

California hospice providers laud state’s newly proposed emergency regulationsMcKnights Home Care; by Suzy Frisch; 6/22/26 The California Hospice and Palliative Care Association (CHAPCA) has praised proposed emergency regulations for hospices issued June 1 that aim to provide more oversight of operators and establish stronger guardrails against scammers. “This is a significant moment for hospice in California,” CHAPCA President and CEO Sheila Clark said in a statement. “CHAPCA welcomes the California Department of Public Health’s proposed emergency regulations for hospice agencies, which we have long called for.”