Literature Review

PARC Retreat explores how aging, workforce strains, and federal debt are reshaping U.S. health care Penn LDI - Leonard Davis Institute of Health Economics; by Hoag Levins; 5/13/26 Penn Gathering of Experts Examines the Growing Pressures Facing Older Americans In predicting the future of U.S. health care, it is important to recognize that the long-term health of the population depends not just on medical policy, innovation, or care delivery, but on whether the federal government can sustainably finance the systems that pay for that care, Penn Wharton School Professor and national budget expert Kent Smetters, PhD, told the May 1, 2026 Penn Population Aging Research Center Annual Retreat. 

Watch recording: JD Vance holds press conference on anti-fraud initiatives Washington Examiner | White House | YouTube | PBS News; by David Zimmermann; 5/13/26 Vice President JD Vance held a press conference Wednesday afternoon on anti-fraud initiatives he has been spearheading alongside other officials. Since March, the vice president has led the White House task force designed to combat fraud across the nation. Reported fraud in Minnesota served as the impetus for the task force’s creation, according to an executive order. 

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.

Empower Oversight widens state fraud queries to New York Hospice Regulator Empower Oversight Whistleblowers & Research, Washington, DC; Press Release; 5/1/26 Empower Oversight has filed a public records request with New York’s Center for Hospice and Palliative Care, the state agency responsible for regulating the hospice industry, as part of its broader investigation into fraud involving federal taxpayer funds. The request seeks documents that shed light on potential systemic failures in hospice oversight, and on how the agency has identified, responded to, or declined to act on known fraud indicators. ... For a copy of the letter click here.

Alliance sounds alarm over federal payment suspensions tactic to fight hospice fraud McKnights Home Care; by Liza Berger; 5/1/26 As the federal government continues to crack down on rampant hospice fraud in California and other states, advocates for the field fear that the government’s latest enforcement effort is unintentionally trapping ethical providers. ... While the government is basing a payment suspension on “a credible allegation of fraud,” the National Alliance for Care at Home worries that the government is using just one metric to justify its “credible allegation.” ... In a post this week, law firm Foley & Lardner LLP CMS defined a “’credible allegation of fraud’ as an allegation of fraud from any source, including but not limited to the following: (1) fraud hotline tips ... verified by further evidence; (2) claims data mining; and (3) patterns identified through provider audits, FCA cases and investigations.”

Social work involvement in advance care planning post US 2016 Medicare policy change: A systematic reviewBMJ Supportive & Palliative Care; by Peiyuan Zhang, Yixuan Wang, Jihyeong Jeong, Kaipeng Wang, John G Cagle; 4/26Since 2016, the US Medicare programme has reimbursed physicians and advanced practice providers for advance care planning (ACP) discussions; however, social workers-who play a critical role in ACP-remain excluded from reimbursement. Across studies, clinical social workers demonstrated strong knowledge of advance directives and reported high levels of confidence in facilitating ACP discussions. Most participants expressed positive attitudes towards ACP and viewed ACP facilitation as a core professional responsibility. Intervention studies suggested that social worker-led ACP initiatives may increase patient engagement in ACP, particularly completion of formal ACP documentation. These findings support ongoing policy discussions regarding the inclusion of social workers in ACP reimbursement frameworks.

NPHI execs: quality is hospices’ differentiator Hospice News; by Jim Parker; 4/28/26 True quality care transcends government-required metrics and is key to shaping the future of hospice care. This is according to Tom Koutsoumpas, founder and CEO of the National Partnership for Healthcare & Hospice Innovation (NPHI), and Carole Fisher, the organization’s president. While factors like regulatory compliance are crucial to quality, they don’t tell the whole story, Koutsoumpas and Fisher told Hospice News at NPHI’s Annual Summit in Chicago. “Quality is our differentiator. In addition to all the scores, certainly patient and family satisfaction is a huge part of it, making sure that we continue to put the patient and family in the center. ...” Koutsoumpas said. “Do we create an atmosphere of trust? That’s a quality issue."

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

CMS educational video: Hospice levels of care and how to bill for service intensity add-on (SIA) payments CMSHHSgov YouTube and CMS MLN Connects Newsletter; posted on CMS's YouTube channel 4/17/26, posted in CMS MLN Connects Newsletter 4/23/26 This video is intended to educate hospices on a service opportunity called a service intensity add-on payment. Hospice agencies are paid a daily rate for each patient enrolled in hospice regardless of the number of services provided on a given day, including days when hospice provides no services. Hospice benefits allow hospices to bill an additional payment on an hourly basis for registered nurse and social worker visits during the last seven days of a patient’s life in addition to their standard daily reimbursement.

Tom Koutsoumpas: California’s hospice fraud crisis demands action Redlands Daily Facts | Commentary; by Tom Koutsoumpas; 4/23/26 Throughout the 1980s, in the early days of building hospice care into the American healthcare system, those of us on the frontlines helped shape what would become the Medicare hospice benefit. It was a turning point in how this country cares for people at the end of life. At its core, the hospice benefit is simple. ... For millions of families, it has meant more dignity, more support, and more time focused on what matters most. That’s why the scale of fraudulent hospice activity in California is so deeply concerning. This is not a gray area. It is widespread fraud, targeting vulnerable patients and exploiting gaps in oversight.