Literature Review

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.

Dying without a safety net MedCityNews; by Darren Schulte; 6/21/26 Recently, I reviewed the case of a woman with advanced metastatic breast cancer – we’ll call her Helen. ... As one therapy after another failed, Helen cycled in and out of the hospital: complications from treatment, complications from the cancer itself, and each time the system responded the only way it knew how – rapid escalation, ICU stays, more procedures, more drugs. Finally, a palliative care team was consulted during her last hospitalization. After long family meetings, Helen was discharged to hospice and died days later. Throughout that final year, Helen suffered. No one on her medical team had documented her wishes, preferences, or goals of care. No one had walked her through the trade-offs she faced with each treatment decision. The system did what it was designed to do, and it failed her completely. 

Five takeaways: Star investigation into alleged Southern Arizona 'cult' Tuscon.com, Tuscon, AZ; by Tim Stellar; 6/18/26 An Arizona Daily Star investigation found that a Southern Arizona religious group is making millions per year from its hospice in Tucson and Tubac, while former members complain the group forces members to work for free, including at that hospice. Former members interviewed described the Global Community Communications Alliance as a "cult," and court filings call it a high-control religious group with a closed campus. Here are five takeaways from the investigation:

CMS recalculates MA star ratings payments in wake of Clover lawsuit Becker's Payer Issues; by Elizabeth Casolo; 6/18/26 CMS is “voluntarily recalculating” 2027 Medicare Advantage quality bonus payment ratings, based on 2026 star ratings, following Clover Health’s successful challenge of the agency’s measures. CMS sent a letter informing health plans June 17. In its reevaluation, CMS will only change a rating if a contract receives a higher quality bonus payment rating than before. The agency removed all Part D and some Part C measures in its review: special needs plan care management, health plan complaints, members choosing to leave, timely appeals decisions, appeals decision reviews, and call center availability of foreign language interpreters and teletypewriters.

Health brief: Hospice purge ensnares legitimate providers Washington Post Intelligence; by Megan R. Wilson; 6/15/26

NPHI calls for thoughtful hospice payment reform that rewards high-quality care National Partnership for Healthcare and Hospice Innovation (NPHI), Washington, DC; Press Release; 6/16/26The National Partnership for Healthcare and Hospice Innovation (NPHI)is calling for thoughtful modernization of the Medicare Hospice Benefit while raising concerns about recommendations contained in a recent Government Accountability Office (GAO) report that could fundamentally alter the hospice benefit and potentially lead to substantial changes in provider reimbursement. NPHI is exploring potential reforms to the current hospice payment structure, including steps to reduce incentives for bad actors and poor-quality care by lowering the hospice aggregate cap, and reallocating dollars within the existing payment methodology to better compensate high-quality, mission-driven providers caring for the sickest patients. NPHI believes these types of reforms would better align reimbursement with patient needs, preserve the core principles of hospice care, and encourage providers to deliver care based on patient need rather than financial incentives. ...

MedPAC Executive Summary - June 2026 report MedPAC; 6/15/26As part of its mandate from the Congress, each June the Commission reports on potential improvements to Medicare payment systems and issues that affect the Medicare program, including changes to health care delivery and the market for health care services. The six chapters of our June 2026 report cover the following topics:

What a CMS fraud chief learned by caring for her parents in hospice Forbes; by Wes Kilgore; 6/11/26  The realization came to Dara Corrigan in late August, when she and her younger sister had to place both of their parents into hospice care within days of each other. Corrigan was not a typical stressed relative, navigating end-of-life care. She'd worked for decades in senior federal service, serving as the Acting Inspector General for the Department of Health and Human Services (HHS) and directing the Center for Program Integrity at the Centers for Medicare & Medicaid Services (CMS). Her career was built on protecting Medicare from fraud. Yet, sitting by the bedside as a daughter, the benefit looked entirely different from how it appeared on a regulatory spreadsheet. ...A New Model for Dignity: Corrigan thinks a completely different approach could be the solution: a new, dedicated federal palliative care benefit tailored to the reality of long, slow neurodegenerative declines. She envisions a system built from day one with modern anti-fraud controls. 

Medicare 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

Neal, 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. 

National 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. ... 

Dr. 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. 

West 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.