Literature Review

Straight from the source: DOJ, OIG, and CMS on fraud and abuse enforcement in 2026 and beyond Mondaq | Legal 500 | Intelligence; by Lorel Writh and Lisa Re; 7/7/26  The American Health Law Association (AHLA) Conference wrapped up today, and its closing general session brought together three federal enforcers: Kim Brandt, Deputy Administrator and COO of Centers for Medicare & Medicaid Services (CMS); Susan Gillin, Assistant Inspector General for Legal Affairs at the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); and Brenna Jenny, Deputy Assistant Attorney General in the U.S. Department of Justice’s (DOJ) Fraud Section. AHLA CEO David Cade moderated. Across the hour, the panel previewed how the three agencies intend to coordinate fraud and abuse enforcement in 2026 and beyond, emphasizing interagency collaboration, a shift from chasing improper payments to preventing them, and the connection between program integrity and affordability.

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. 

New GAO report on assisted living: Value, not federal oversight, should be takeaway, providers say McKnights Senior Living; by Lois A. Bowers; 7/6/26 A new report about assisted living from the US Government Accountability Office reinforces the value of the setting and the appropriateness of regulation occurring at the state level, industry advocates told McKnight’s Senior Living on Monday. Senators who requested the report, however, said that the report “reveals [a] need for federal oversight." The seven Democrats on the Senate Special Committee on Aging in January 2024 asked the GAO to study the cost and scope of the provision of assisted living services to Medicaid and Medicare beneficiaries who live in assisted living communities, among other matters. The GAO publicly released its findings Thursday.

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:

Guardianship and hospice care fail dying patients MedPage Today's KevinMD.com; by Kirsten Engel, MD & Madha Tripathi; 6/3/26 “Mr. L” is alone, lying flat on his back in a slightly inclined bed, eyes squeezed shut, hands raised in the air as immobile fists. He has not spoken in weeks. ... The medical team calls it catatonia, a severe psychiatric syndrome that has rendered him mute, immobile, and medically fragile. The psychiatric care team has recommended comfort measures, and our hospice team is ready to accept him. ... Mr. L cannot access hospice because an overworked stranger appointed by the court has not yet returned the hospital’s calls. This is a guardian, a professional fiduciary who has never met Mr. L, who must sign the papers first. So we wait for the court to hold a hearing to approve the order. And Mr. L, still, silent, and suffering, waits with us.

Hospice in the spotlight – audits, PEPPER, and patient autonomy RACmonitor; by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 7/1/26 .. why talk hospice now? Because it seems to be hospice’s time to be in the spotlight. ... Last week you likely heard about a big U.S. Department of Justice (DOJ) $6.5 billion fraud takedown. Included in that was another hospice fraud scheme that included a funeral home employee who sold information on recently deceased people to a fraudster who then submitted claims for hospice services that were never provided. ...Then, the Centers for Medicare & Medicaid Services (CMS) has released the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for hospice organizations. And to top it off, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an audit of hospice claims finding that Medicare paid over $255 million for patients who were not eligible for hospice care. ...

CMS is right about hospice fraud but wrong about the moratorium on new enrollments Health Affairs; by Tamara Weaver; 6/30/26 Under CMS’s six-month moratorium on new enrollments, I have effectively been told to sit still, burn cash, and hope I survive long enough to eventually serve patients. That is not good policy. That is collateral damage. I am exactly the kind of hospice agency owner the federal government should want in this industry. I am not a private equity fund. I am not a shell company. I am not a fraudster who enrolled patients who did not qualify, billed for services never rendered, or relocated across state lines to outrun regulators. I am a founder who spent years building something genuinely different—investing my life savings, my retirement, and my professional identity into a mission-driven hospice designed specifically as an antidote to the failures that have eroded trust in end-of-life care. ...

CMS creates new health tech office to lead interoperability efforts, digital products Fierce Healthcare; by Heather Landi; 6/15/26 The Centers for Medicare and Medicaid Services (CMS) aims to play a bigger role in health tech modernization efforts, including leading interoperability initiatives. The agency created a new Office of Health Technology and Products (OHTP) to provide "enterprise leadership and oversight for CMS healthcare technology modernization, digital products and transformation of platforms and services supporting Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and other CMS-administered programs," according to a notice in the Federal Register published on June 11. The new health tech-focused office will work in close coordination with the CMS Chief Information Officer (CIO) and will lead enterprise strategy for artificial intelligence, interoperability, digital product development, Medicare.gov, provider directories and claims system modernization, according to the notice. The office consists of eight divisions and the notice lists more than 90 responsibilities.Editor's Note: Examine the detailed Federal Register's "Statement of Organization, Functions, and Delegations of Authority"

CMS proposes community-based palliative care benefit Hospice News; by Jim Parker; 7/1/26 The U.S Centers for Medicare & Medicaid Services (CMS) has proposed coverage of community-based palliative care through the Medicare home health benefit. CMS included the palliative benefit in its 2027 proposed home health rule. ... The agency emphasized that palliative care under the home health benefit would be separate from hospice care and could support patients earlier in the course of serious illness.

Solace Hospice suspends opening amid Medicare moratorium Hospice News; by Holly Vossel; 6/25/26 The launch of Solace Hospice of Southwest Virginia has paused due to a nationwide temporary moratoria on hospice and home health Medicare enrollment. The hospice’s operations will be suspended for an indeterminate time. The U.S. Centers for Medicare & Medicaid Services’ (CMS) six-month moratoria took effect on May 13, a move to halt new providers amid fraudulent activity in the hospice space. The program’s cessation is a direct result of the moratorium, said Shanna Western, founder and executive director of Solace Hospice of Southwest Virginia.

National health care fraud takedown results in 455 defendants charged in connection with over $6.5 billion in alleged fraud Office of Public Affairs - U.S. Department of Justice, Washington, DC; Press Release; 6/23/26Record Medicaid Fraud Charges Largest Number of States Participating in Health Care Fraud Takedown History: The Justice Department today announced the 2026 National Health Care Fraud Takedown, which resulted in charges against 455 defendants, including 90 doctors and other licensed medical professionals, for their alleged participation in health care fraud and opioid abuse schemes involving over $6.5 billion in false claims and significant patient harm, including death. Today’s Takedown represents a new era in federal, state, and international cooperation to combat health care fraud: cases in 56 federal districts and 45 U.S. states and territories, with 50 state Medicaid Fraud Control Units participating, the most in Department history.

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 Thirteen defendants were among those charged in the Northern District of Texas as part of the 2026 National Health Care Fraud Takedown, announced United States Attorney for the Northern District of Texas Ryan Raybould, during a press conference held earlier today. The charges announced today ... resulted in charges against 455 defendants, including 90 doctors and other licensed medical professionals, for their alleged participation in health care fraud and opioid abuse schemes involving over $6.5 billion in false claims and significant patient harm, including death. Today’s Takedown represents a new era in federal, state, and international cooperation to combat health care fraud: cases in 56 federal districts and 45 U.S. states and territories, with 50 state Medicaid Fraud Control Units participating, the most in Department history.

Medicare could have saved $255.1 Million related to hospice services for certain new hospice enrollees United States Government HHS-Office of the Inspector General (OIG), Report number: A-06-22-09003; issued on 6/18/2026, posted on 6/23/26 [From the Full Report]: Our objective was to determine whether the Centers for Medicare & Medicaid Services (CMS) made Medicare payments to hospices for certain new hospice enrollees in accordance with Medicare requirements.