Literature Review

CMS oversight did not prevent Medicare Part D sponsors from making $587.7 million in ineligible payments to pharmacies for drugs available over the counter but labeled as prescription-only United States Government HHS-OIG; Report number OAS-24-02-004; issued on 8/31/26, posted on 9/2/26 

The hospice moratorium: what CMS is really signaling about the future | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Jennifer Kennedy; 9/2/26 In Part One of this timely conversation, host Chris Comeaux and co-host Cordt Kassner,  sit down with Dr. Jennifer Kennedy, Vice President for Quality, Standards and Compliance at CHAP, to unpack what the CMS hospice moratorium means, why it was implemented, and what hospice leaders should be watching next.  Jennifer explains how escalating concerns around fraud and abuse, rapid market expansion, transactional hospice models, accreditation oversight, and Medicare enrollment have created an unprecedented regulatory environment.  She also shares why she believes the moratorium could be extended as CMS continues strengthening enrollment screening and program-integrity efforts.

Alliance submits comments in response to CY 2027 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA; Press Release; 9/1/26 The National Alliance for Care at Home (the Alliance) has submitted comments in response to the Centers for Medicare & Medicaid Services’ Calendar Year (CY) 2027 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule.  The letter notes that the Alliance appreciates that, for the first time since CY 2022, CMS proposes a full annual payment update, does not propose to apply a new permanent adjustment, [and ...] However, the comment also emphasizes that these decisions do not undo the harm already built into the payment rate, nor do they do enough to protect access to care across the country. 

CHAP: The Compliance Monitor 9/1/26 Community Health Accreditation Partner (CHAP); 9/1/26August/September 2026 Compliance Activity:

AHA comments on CY 2027 Home Health proposed payment rule American Hospital Association; Press Release; 8/28/26 On behalf of our nearly 5,000 member hospitals, health systems and other healthcare organizations, including approximately 1,000 hospital-based home health (HH) agencies, our clinician partners — more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 healthcare leaders who belong to our professional membership groups, ... The AHA has two significant concerns. First, CMS’ proposed payment update of 2.4% is inadequate. ... Second, the proposed rule includes substantial changes to Medicare provider enrollment authorities that would apply not only to HH agencies but also to all providers and suppliers enrolled in Medicare. 

Week ahead in health care: MedPAC meeting with in-person audience Inside Health Policy; by Jessica Karins and Amy Lotven; 8/28/26 The Medicare Payment Advisory Commission (MedPAC) will meet Thursday (Sept. 3) and Friday (Sept. 4) virtually and, for the second time since the COVID-19 pandemic, with limited in-person public seating.

California and the federal government battle over hospice fraud, as victims lose coverage and care Regional Media News, Los Angeles, CA; by wrnnews.com; 8/26/26At 71 and a few years into retirement, Linda Henry felt like she was in good health, and only went to her doctor in Southern California for the occasional checkup. So it was a shock when she found out in 2024 that she had been enrolled in hospice, a specialized end-of-life care usually provided to people with six months or less to live. A Medicare worker told her the system said she had heart failure. Henry was a victim of rampant fraud in the hospice industry, a problem that’s been especially extreme in California, ... Henry believes her Medicare number was stolen after a healthcare payment portal that services insurances was hit by a cyberattack. She found out about her hospice enrollment in September 2024 after her doctor billed Medicare for an allergy test and was denied. Soon, other claims were being returned unpaid.

American Society of Nephrology (ASN) comments on CY2027 ESRD PPS QIP Requests for Information (RFIs)American Society of Nephrology; official comments letter from ASN to Centers for Medicare & Medicaid Services; 8/24/26RE: CMS-1846 Medicare Program; CY2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury Dialysis (AKI) Payment, and ESRD Quality Incentive Program On behalf of the more than 37,000,000 Americans living with kidney diseases and the 22,000 nephrologists, scientists, and other kidney health care professionals who comprise the American Society of Nephrology (ASN) ... In this letter, ASN provides feedback on the following requests of information (RFIs): ...

Wound care fraud: key insights for healthcare providers in 2026 JD Supra; by Lynette Byrd; 8/21/26 The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) are prioritizing wound care fraud enforcement in 2026. Healthcare providers are facing scrutiny under the False Claims Act and Anti-Kickback Statute, with audits and investigations leading to substantial liability (among other consequences) in many cases. ... Allegations of wound care-related health care fraud can take many different forms. ... While it is critical that elderly patients (including hospice patients and other terminally ill patients) receive appropriate care, there are limits to what is considered appropriate when billing Medicare or Medicaid for wound care. ...

CMS hospice payment suspensions slamming vendors Hospice News; by Jim Parker; 8/21/26 ... CMS earlier this year began suspending Medicare payments to hundreds of hospices allegedly due to suspected fraud. ... Evidence indicates that some legitimate hospices were caught up in the dragnet due to patients being discharged for valid reasons, such as a revocation of the benefit, moving out of a provider’s service area or transfer to another hospice. ... These regulatory actions have had a ripple effect on vendors, according to a DME company CEO that spoke to Hospice News on background. “These hospice agencies are being suspended. They’re not getting paid,” the DME CEO told Hospice News. “If they’re not getting paid, their employees are not getting paid. DME providers like us are not getting paid. Pharmacies are not getting paid. Any other contractor they have is not getting paid.” This has placed some vendor businesses in peril, and some of them have been considering layoffs of their own, another DME provider ... told Hospice News, “We’ve been trying to keep everybody on board, keep them employed, keep them paid for as long as we possibly can.”

Hospice Wage Index, the Final Rule, and the signals CMS is sending | part one Teleios Collaborative Network (TCN); pocast hosted by Chris Comeaux with Annette Kiser and Judi Lund Person The 2027 Hospice Final Rule is more than a reimbursement update—it’s a window into where Centers for Medicare & Medicaid Services (CMS) believes hospice care needs to go next. In Part One, host Chris Comeaux sits down with hospice regulatory experts Annette Kiser and Judi Lund Person to look beyond the numbers and “read the tea leaves” in CMS’s latest rule.  They unpack what hospice leaders need to understand about the Hospice Election Statement Addendum, the growing scrutiny of unrelated services and non-hospice Medicare spending, telehealth reporting, and the Service and Spending Variation Index (SSVI).  As Judi explains, CMS’s commentary and responses to industry feedback can reveal as much about the agency’s direction as the regulations themselves.

Nearly one in five Medicare hospice patients now leaves the program alive rather than through death Medical Daily; by Dorothy Brooks; 8/17/26 Almost one in five people who leave Medicare hospice care each year leaves alive rather than through death, and the share has climbed every year since 2021. Federal data released this spring put the live discharge rate at 19.1 percent in fiscal year 2025, up from 16.9 percent four years earlier. For families, this is the rule almost nobody explains at enrollment. Hospice is not a permanent placement. It is a benefit tied to a prognosis, and when that prognosis changes, the benefit can end while the patient is still living, still ill, and still needing care. Understanding it before it happens is the difference between a planned transition and a phone call that lands like an eviction.

When a hospice patient comes to the hospitalICD10monitor; by Tiffany Ferguson, LMSW, CMAC, ACM; 8/17/26 A recent question was posed related to “What happens when a hospice enrolled patient returns to the hospital for emergency or hospital care?” Aside from the initial questions such as “did we even know this patient was on hospice when they roll through the emergency room, or why did they come back to the hospital? The next question may evolve to the following: is the treatment still involving care congruent with the patient’s hospice care plan or has the patient/representative elected to revoke their hospice services? Understanding these distinctions is increasingly important for case management, utilization review, registration, revenue cycle, and especially hospital clinical teams.