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All posts tagged with “Regulatory News | Medicare.”
Medicare hospice: action needed to pay more efficiently for routine home care
06/11/26 at 03:00 AMMedicare hospice: action needed to pay more efficiently for routine home care GAO - U.S. Government Accountability Office; GAO-26-107585; publicly released 6/9/26 Fast Facts
California proposes emergency hospice regulations amid fraud
06/11/26 at 03:00 AMCalifornia proposes emergency hospice regulations amid fraud Hospice News; by Holly Vossel; 6/9/26 The California Department of Public Health has proposed emergency hospice regulations to address fraudulent activity in the state. The proposal includes the establishment of more stringent criteria to better evaluate the legitimacy of new hospice businesses. ... Among other provisions, the proposed emergency regulations included new adoptions of standardized definitions related to hospice services and marketing information, license applications, as well as for staff personnel qualifications and responsibilities of administrators, attending physicians and authorized care providers.
Neal, Sánchez release new GAO report finding the necessity of Sánchez’s Hospice CARE Act
06/11/26 at 02:00 AMNeal, Sánchez release new GAO report finding the cecessity of Sánchez’s Hospice CARE Act U.S. Ways & Means Committee - Ranking Member Richard E. Neal, Washington, DC; Press Release; 6/9/26Ways and Means Committee Ranking Member Richard E. Neal (D-MA) and Ways and Means Trade Subcommittee Ranking Member Linda T. Sánchez (D-CA) today [6/9/26] highlighted a new report from the nonpartisan U.S. Government Accountability Office (GAO) finding that Congress must reform the Medicare hospice benefit to address misaligned payment incentives, reduce excessive spending, and root out fraudsters. Neal requested this report back in May 2023, and Sánchez leads legislation to modernize the Medicare hospice benefit while also safeguarding against fraud. ...Editor's Note: For a more comprehensive understanding and response, examine The full GAO report and the National Alliance for Care at Home responds to GAO report regarding Medicare hospice payment.
AHA comments on CMS’ FY 2027 LTCH Prospective Payment System Proposed Rule
06/10/26 at 03:10 AMAHA comments on CMS’ FY 2027 LTCH Prospective Payment System Proposed Rule American Hospital Association; letter from Ashley Thompson, AHA Sr VP Public Policy Analysis and Development to Dr. Mehmet Oz, CMS Administrator; 6/8/26 On behalf of our nearly 5,000 member hospitals, health systems and other healthcare organizations, including approximately 230 long-term care hospitals (LTCHs); 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 American Hospital Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS’) fiscal year (FY) 2027 LTCH prospective payment system (PPS) proposed rule. ... Our detailed comments follow.
National Alliance for Care at Home responds to GAO report regarding Medicare hospice payment
06/10/26 at 02:00 AMNational Alliance for Care at Home responds to GAO report regarding Medicare hospice payment The National Alliance for Care at Home (The Alliance), Alexandria, VA; Press Release; 6/9/26 The National Alliance for Care at Home (the Alliance) today responded to a new report from the Government Accountability Office (GAO) recommending that Congress consider directing the Department of Health and Human Services to restructure the Medicare hospice payment system to better promote routine home care payment efficiency. ... The GAO report asserts that shifting hospice to per-visit payment rates comparable to home health would have reduced Medicare spending by $7.6 billion for a selected group of beneficiaries in 2024. However, these savings are generated in part by paying less to “low visit” hospices that are concentrated in known high-fraud areas. ...
Nevada Health Authority announces pause on new state licenses for hospice, home-health services as officials investigate possible Medicaid fraud
06/08/26 at 03:00 AMNevada Health Authority announces pause on new state licenses for hospice, home-health services as officials investigate possible Medicaid fraud KLAS, Las Vegas; by Linsey Lewis; 6/5/26 The Nevada Health Authority announced a temporary pause on new state licenses for hospice and home-health services as state officials conduct “extensive” reviews of all Medicaid-enrolled hospice and home-health providers to identify cases of fraud. The pause on new state licenses for hospice and home-health providers and a moratorium on new enrollments for Nevada Medicaid come as fraud in the hospice and home-healthcare spaces garners national attention with high-dollar crimes from Medicaid and Medicare billing activities and fake operations.
Dr. Joan Teno exposes the hidden problems with hospice ratings and quality scores | part two
06/08/26 at 12:00 AMDr. Joan Teno exposes the hidden problems with hospice ratings and quality scores | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Joan Teno; 6/3/26 What if the hospice ratings patients and families rely on don’t tell the full story? In Part One of this thought-provoking conversation, renowned hospice researcher and policy expert Dr. Joan Teno joins Chris Comeaux and Cordt Kassner to unpack the hidden flaws within today’s hospice quality measurement systems. Drawing on more than 30 years of experience shaping hospice and palliative care policy, Dr. Teno explains why many publicly reported quality measures may fail to capture the true experiences of patients and families. She discusses the challenges of transparency, the unintended consequences of current reporting systems, concerns about fraud and oversight, and how artificial intelligence could help transform the future of hospice quality measurement.
Implications of Medicare negotiation and most-favored-nation pricing for cancer medicine costs
06/06/26 at 03:10 AMWest Coast fraud and AI: DOJ expands healthcare fraud enforcement into technology-driven markets
06/05/26 at 03:00 AMWest Coast fraud and AI: DOJ expands healthcare fraud enforcement into technology-driven markets JDSupra | Proskauer Health Care Law Brief; by Devin Cohen, Lara Feder, Matthew Westbrook; 6/3/26 On April 30, 2026, the Department of Justice (“DOJ”) announced the creation of the West Coast Health Care Fraud Strike Force, a coordinated enforcement initiative focused on healthcare fraud in Arizona, Nevada, and Northern California. ... DOJ’s announcement also reflects the government’s growing focus on technology-enabled healthcare fraud risks. ... In its announcement, DOJ specifically highlights recent prosecutions involving digital health executives and healthcare technology-related fraud schemes in Northern California and Arizona.
Hospice advocates push back on CMS’ proposed program integrity scoring system
06/05/26 at 03:00 AMHospice advocates push back on CMS’ proposed program integrity scoring system McKnights Home Care; by Liza Berger; 6/3/26 In recent comments to the Centers for Medicare & Medicaid Services, hospice advocates criticized the new scoring system, the Service and Spending Variation Index, or SSVI, that CMS put forth in its fiscal year 2027 hospice proposed rule in April to curb fraud in the sector. They cited a flawed methodology underlying the scores and called for CMS to take down two years of publicly posted data. ...The National Alliance for Care at Home pointed to inaccurate scoring in publicly posted data. “This data could cause substantial reputational harm to hospices for mistakes made by CMS in file construction and assigning scores,” Jennifer Sheets, CEO said.LeadingAge said the nonhospice spending measure “lacks transparency, disregards the influence of size and scale, includes questionable data, and is entirely inactionable for hospices.” Such a measure could target the wrong providers, LeadingAge argued. Editor's Note: Explore details from The Alliance, LeadingAge, and NPHI.
Trellis Supportive Care supports CMS efforts to strengthen hospice oversight
06/05/26 at 03:00 AMTrellis Supportive Care supports CMS efforts to strengthen hospice oversight The Stokes News, Winston Salem, NC; by Ann Gauthreaux; 6/3/25 [Background information about the CMS Hospice six-month moratorium] “Hospice care should always represent dignity, compassion, and trust,” said Dr. Mike Lalor, CEO of Trellis Supportive Care. “Actions that address bad actors in our industry are necessary to preserve the integrity of hospice and ensure that patients receive the quality care they deserve.” Trellis Supportive Care wants to reassure patients, families, referral partners, and the broader community that this moratorium does not impact its services or operations. The organization continues to provide hospice, palliative, and supportive care throughout the region without interruption.
Medicare warns seniors of fraudulent offers for "free" medical equipment and hospice services
06/05/26 at 03:00 AMMedicare warns seniors of fraudulent offers for "free" medical equipment and hospice servicesWBIW.com, Indiana; 6/3/26 Federal health officials are urging older Americans to stay vigilant against a surge in healthcare scams targeting Medicare beneficiaries with promises of "free" medical supplies and services. ...
Dr. Joan Teno exposes the hidden problems with hospice ratings and quality scores | part one
06/04/26 at 03:00 AMDr. Joan Teno exposes the hidden problems with hospice ratings and quality scores | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Joan Teno; 6/3/26 What if the hospice ratings patients and families rely on don’t tell the full story? In Part One of this thought-provoking conversation, renowned hospice researcher and policy expert Dr. Joan Teno joins Chris Comeaux and Cordt Kassner to unpack the hidden flaws within today’s hospice quality measurement systems. Drawing on more than 30 years of experience shaping hospice and palliative care policy, Dr. Teno explains why many publicly reported quality measures may fail to capture the true experiences of patients and families. She discusses the challenges of transparency, the unintended consequences of current reporting systems, concerns about fraud and oversight, and how artificial intelligence could help transform the future of hospice quality measurement.
NPHI submits comments on FY 2027 Hospice Proposed Rule, urges CMS to strengthen transparency, support access, and advance meaningful reform
06/04/26 at 02:00 AMNPHI submits comments on FY 2027 Hospice Proposed Rule, urges CMS to strengthen transparency, support access, and advance meaningful reform National Partnership for Healthcare and Hospice Innovation, Washington, DC; Press Release; 6/2/26The National Partnership for Healthcare and Hospice Innovation (NPHI), the national voice for nonprofit hospice and advanced illness care, has submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) regarding the Fiscal Year (FY) 2027 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements proposed rule. In the letter, NPHI welcomed CMS’s continued engagement with hospice stakeholders and offered detailed recommendations designed to strengthen patient access, improve transparency, reduce unnecessary administrative burden, and support high-quality, community-based hospice and palliative care.
National Alliance for Care at Home voices concerns to CMS in response to the FY 2027 Hospice Proposed Rule
06/03/26 at 02:00 AMNational Alliance for Care at Home voices concerns to CMS in response to the FY 2027 Hospice Proposed Rule National Alliance for Care at Home, Alexandria, VA; Press Release; 6/2/26 The National Alliance for Care at Home (the Alliance) submitted comments in response to the Centers for Medicare & Medicaid Services’ (CMS) Fiscal Year (FY) 2027 Hospice Wage Index proposed rule, which proposes payment and regulatory updates under the Medicare hospice benefit. The letter states that the proposed 2.4% hospice payment update for FY 2027 will not adequately account for the cost pressures hospice providers face in today’s healthcare delivery market.
Ohio toughens Medicaid fraud prevention with new initiatives
06/02/26 at 03:00 AMOhio toughens Medicaid fraud prevention with new initiatives Epstein Becker Green Law; by Ann Parks; 5/29/26 On May 13, 2026, Ohio Governor Mike DeWine announced new Medicaid fraud prevention initiatives focusing on home health and hospice providers from the Ohio Department of Medicaid (ODM). Governor DeWine also issued an Executive Order on May 18, 2026, directing new emergency rules for multiple provider enrollment enforcement actions including revalidations of identified high-risk providers.
CMS reportedly unresponsive to hospice payment suspension rebuttals
06/02/26 at 01:00 AMCMS reportedly unresponsive to hospice payment suspension rebuttals Hospice News; by Jim Parker; 5/29/26 The U.S. Centers for Medicare & Medicaid Services (CMS) has been largely unresponsive to hospices’ rebuttals to payment suspensions due to suspicion of fraud. Legitimate hospice providers are being swept into CMS’ broader fraud crackdown, with some agencies reportedly facing payment suspensions severe enough to force closures. ... Hospice News has spoken with 10 hospices that have received suspension letters; each indicated that the block on their payments was based on a single metric — live discharges. Suspended hospices have the ability to file a rebuttal seeking to have the payment freeze reversed. However, to date, few hospices have received any response from CMS or its Unified Program Integrity Contractors (UPIC).
CMS myth vs. fact: what hospice and home health providers need to know about the new Medicare enrollment moratoria
06/01/26 at 03:10 AMCMS myth vs. fact: what hospice and home health providers need to know about the new Medicare enrollment moratoria JD Supra; by Stephen Angelette, Mary Canavan, Simran Nijjar, Ross Sallade, Elizabeth Tucker, and Deja Williams; 5/26/26 [Responding to the CMS nationwide six-month moratoria barring new Medicare enrollments for hospice and home health agencies (HHAs), effective May 13 ... ] Any actions that trigger an initial Medicare enrollment are prohibited during the moratoria. This can include changes in ownership, new practice locations, additions of provider types, or other transactions requiring a new enrollment application.In this alert, we address common myths surrounding the moratoria and key considerations for providers during the six-month period. Guest Editor's Note, Judi Lund Person: Review this guidance for application to your hospice or home health planning, including mergers, acquisitions, and establishment of new practice locations or new branches.
CMS relaunching Hospice PEPPER Report in June 2026
06/01/26 at 03:00 AMCMS relaunching Hospice PEPPER Report in June 2026 LeadingAge; by Katy Barnett; 5/27/26 The Centers for Medicare and Medicaid temporarily paused PEPPER reports in January 2024, but over the last several months, the agency has released updated reports for other Medicare provider settings, such as critical access hospitals and short-term acute care hospitals.
Get ready to access the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER)
05/29/26 at 03:00 AMGet ready to access the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER)CMS Center for Program Integrity; 5/28/26 CPI is getting really close to releasing the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER). The Hospice PEPPER will be available through the PEPPER Portal in early June 2026. To ensure hospice providers can successfully access their reports, we ask that you distribute the following instructions to your members.
Public Notice: Nine compete to develop hospice home care office in McDowell County
05/27/26 at 02:00 AMPublic Notice: Nine compete to develop hospice home care office in McDowell County North Carolina Department of Health and Human Services; 5/11/26 Nine applicants have filed certificate of need applications with the North Carolina Department of Health and Human Services to develop a hospice home care office in response to a need determination in the 2026 State Medical Facilities Plan (SMFP). Each applicant proposes one project.
CMS targeting Georgia, Ohio in fraud fight
05/26/26 at 03:00 AMCMS targeting Georgia, Ohio in fraud fight Hospice News; by Jim Parker; 5/22/26 Ohio and Georgia are seeing a large influx of new hospice operators, leading some to suspect that fraud is becoming more prevalent in those states. The four states that historically have been hotbeds for fraud — California, Arizona, Nevada and Texas — also saw hosts of new providers enter their markets, many of which were malfeasant. Among other efforts to combat the ongoing fraud, the U.S. Centers for Medicare and Medicaid Services (CMS) in 2023 instituted a provisional period of enhanced oversight for those four states. That has now been extended into Georgia and Ohio, retroactive to Dec. 31, 2025.
Ways and Means: Approved policies fight fraud in critical safety net programs
05/26/26 at 02:00 AMWays and Means-approved policies fight fraud in critical safety net programs United States House Committe on Ways & Means - Chairman Jason Smith, Washington, DC; Press Release; 5/22/26 Ways and Means Republicans advanced anti-fraud legislation after months of hearings that revealed the extent of fraud and mismanagement in vital programs like Medicare, Temporary Assistance for Needy Families (TANF), and unemployment insurance. ... [Go directly to the Ways & Committee Fact Sheet, released on Friday 5/22/26, with information and links below to a Fact Sheet for each newly approved policy.]
CMS clarifies telehealth policy during enrollment moratorium
05/25/26 at 03:00 AMCMS clarifies telehealth policy during enrollment moratorium Hospice News; by Jim Parker; 5/21/26 Hospices will continue to be able to use telehealth for face-to-face recertifications during the hospice and home health enrollment moratorium, according to the U.S. Centers for Medicare & Medicaid Services’ (CMS). ... The federal statute stipulates that telehealth recertifications are not permitted in regions that are under an enrollment moratorium. This has raised some questions about how hospices can use telehealth for the next six months. “Perhaps the most troubling unintended consequence of a nationwide moratorium is its apparent impact on telehealth …” a trio of state associations said in a joint statement. “In rural communities and congested urban areas alike, this imposes severe and unnecessary burdens on the most vulnerable patients at the most vulnerable moments of their lives.”
Hospice fraud is real — but so is ethical hospice care
05/25/26 at 02:00 AMHospice fraud is real — but so is ethical hospice care Mountain Democrat, Placerville, CA; by Tim Meadows, CEO of Snowline Health; Molly Corbett, CEO of Livingston Memorial Visiting Nurse Association & Hospice; Deanna Brooks, CEO of Hospice of San Joaquin; Sarah McSpadden, CEO of The Elizabeth Hospice; and Craig Dressang, CEP of YoloCares; 5/20/26 Recent headlines detailing hospice fraud investigations across California are deeply troubling. ... These investigations are necessary, long overdue and effective. ... However, amid this justified scrutiny, it is critical not to lose sight of an equally important truth: Hospice fraud is not hospice care. ... Just as important, there are clear ways to identify ethical hospice providers. Families can protect themselves by taking a few simple, informed steps: