Literature Review

Ready, Fire, Aim: The CY 2027 Home Health Proposed Rule's shoot-first approach to provider enrollment Husch Blackwell | Hospice Insights; by Bryan Nowicki and Andrew Brenton; 8/26/26 CMS’s CY 2027 Home Health Proposed Rule tucks a sweeping set of Medicare provider enrollment changes inside what is nominally a routine payment rule, expanding the grounds on which CMS can deny or revoke a provider’s enrollment. In this episode, Husch Blackwell’s Bryan Nowicki and Andrew Brenton unpack several of the rule’s most consequential proposals, including new denial and revocation grounds and retroactive revocation effective dates. They also discuss why home health agencies and hospices should be paying close attention as the rule moves toward finalization.

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.

What CMS's CY2027 home health proposal means for palliative care JD Supra; by Edo Banach and Lauren Carboni; 8/25/26  The Centers for Medicare & Medicaid Services’ (“CMS”) CY 2027 Home Health Prospective Payment System proposed rule (“HH PPS Proposed Rule”) confirms that community-based palliative care may be covered under the existing Medicare home health benefit-creating near-term operational questions, and longer-term strategic opportunities, for home health agencies, hospices, and other health care providers serving a frail and declining population.Key Takeaways:

Finding Medicare Fee-for-Service (FFS) Payment System Rules: schedules and resources Congressional Research Service - Informing the legislative debate since 1914; by Congressional Research Service, summary by Michele L. Malloy; updated 8/14/26 The Medicare Fee-for-Service (FFS) program pays physicians, hospitals, and other health care facilities based on statutorily established payment systems, most of which are updated annually through regulations. The publication of Medicare FFS proposed and final rules follow schedules based on requirements found in statute, regulation, or both. ... This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the payment systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued proposed rules, public comments, final rules, and subsequent corrections.

Modernizing payment integrity in an era of systemic fraud MedCityNews; by Christian Bass; 8/21/26 Across the United States, Medicaid and Medicare fraud cases are surfacing with increasing frequency — and scale. From improper billing and undocumented services to upcoding and duplicate claims, these cases span federal programs and state-administered Medicaid plans. Once perceived as isolated misconduct, these cases are now being exposed as a systemic challenge, revealing vulnerabilities in reimbursement oversight that affect payers, regulators, and ultimately taxpayers. ... Gaps in reimbursement oversight and recovery will only widen, unless plans modernize how they detect, investigate, and recoup improper payments. Organizations that respond quickly will be positioned to manage the financial and regulatory headwinds.

READOUT: FinCEN holds engagement to eliminate hospice fraud in CaliforniaU.S. Treasure Financial Crimes Enforcement Network, Los Angeles, CA; 8/19/26 On August 17, the U.S. Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN) convened law enforcement and financial institutions for an engagement on health care benefits fraud, including the exploitation of hospice care services. Participants discussed new and emerging health care fraud schemes targeting federal and state health insurance programs, associated financial typologies and red flag indicators, and opportunities to boost awareness around hospice care fraud. Additionally, FinCEN held a training session for law enforcement on August 18 on how to use Bank Secrecy Act data to combat fraud. These engagements build on FinCEN’s work to counter fraud in partnership with the White House Task Force to Eliminate Fraud. 

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.

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.

How SNF upper payment limits can hurt hospices Hospice News; by Brandyn Simmons; 8/17/2 When it comes to healthcare — especially if it involves Medicare or Medicaid — one solution can lead to new problems. The Upper Payment Limit (UPL) program is no exception to this rule. Across the spectrum in healthcare, Medicaid reimbursements have typically been inadequate in covering all expenses for patient care. This is where the UPL comes in. Under this initiative, providers such as skilled nursing facilities (SNF) can receive a gap payment through Medicare to make up the difference. While this is a boon for SNFs, this can become a major headache for many hospice companies across the United States. ...

DOJ’s National Fraud Enforcement Division announces priorities ReedSmith; by Scot T. Hasselman, Selina P. Coleman, Matthew K. Loughran; 8/14/26 In an August 13 memo, Assistant Attorney General Colin M. McDonald set forth the priorities of the Department of Justice (DOJ) National Fraud Enforcement Division that will be focused primarily on criminal public benefits fraud and misuse of taxpayer dollars. In the health care space, the primary targets in include home health agencies and hospice providers, as well as pharmacists and physicians who may be involved in drug diversion. ... The McDonald memo details some of the efforts that the division will focus on when attempting to combat health care fraud. According to the memo, approximately 3 to 10 percent of all health care spending is the result of fraud. ... While the McDonald memo has limited details, it breaks down four other specific categories of fraud that the division will seek to prosecute.

California’s new emergency hospice regulations: key requirements for providers JD Supra; by Margia Corner, Elicia Grilley Green, Lena Zinner; 8/13/26 For the first time in California’s history, hospice agencies have become subject to comprehensive hospice-specific licensing regulations adopted on an emergency basis and effective June 22, 2026. ... The new regulations apply to both existing licensees and new applicants, add significant new requirements for CDPH approval of transactions and other operational changes, such as the licensee’s physical location, and authorize CDPH to conduct unannounced inspections to verify compliance. Providers would benefit from reviewing their operations against the new requirements below.

Regulatory hurdles slowing hospice acquisitionsHospice News; by Jim Parker; 8/10/26 Regulatory uncertainty has been one of the biggest factors influencing mergers and acquisitions (M&A) in the home health and hospice sectors. In this interview, Cory Mertz, managing partner with the M&A advisory firm Mertz Taggart, discusses how the proposed home health payment rule, heightened regulatory scrutiny and compliance expectations are affecting deal activity, as well as the trends shaping the market in 2026.

How California’s hospice industry spiraled out of control — and cost millions in fraud Los Angeles Daily News, Los Angeles, CA; by Jason Henry; 8/9/26 A quiet change in California law in 2018 unleashed a deluge of new hospices and spurred millions of dollars in Medicare fraud that state and federal authorities are still trying to unwind. ... It all started with three paragraphs added, at the request of the California Department of Public Health, to the end of an omnibus bill in 2018. CDPH had a backlog of 72 applications for hospice licenses at the time and wanted legislators to provide an alternative to a major bottleneck: its own inspectors. Under SB 1495, hospices could choose to pay a third-party accrediting organization for the inspection needed for a license, instead of waiting weeks or months for the next available state employee. ... Unlike a restaurant, which must undergo fire, building and health inspections, the vast majority of hospices in California could suddenly obtain a license, and even approval to bill Medicare, without a public employee stepping foot on the property. ...