Literature Review

Hospice compliance in the data driven era | a leadership advisory on enforcement risk and governance readiness JD Supra; by Ankura; 7/9/26 Hospice enforcement has entered a structurally different phase. Oversight is no longer episodic or complaint‑driven; it is continuous, data‑driven, and predictive. Federal agencies increasingly identify risk through utilization analytics — length of stay, live discharges, diagnosis mix, and level‑of‑care patterns — before auditors ever review records. By the time a hospice receives an audit or payment action, the organization has often already been characterized as an outlier. ... From a leadership perspective, the most consequential insight is how eligibility is evaluated. Regulators assess hospice eligibility longitudinally, across the entire patient stay — not at isolated certification points. ...

Why joint ventures may outpace M&A during the CMS home health enrollment moratorium Home Health Care News; by MK Manoylov; 7/14/26 The Centers for Medicare & Medicaid Services’ (CMS) six-month moratorium on new Medicare home health enrollments limits one pathway for providers to scale, but operators can still expand organically and through M&A. Growth-minded operators can increase census, improve workforce availability, acquire other businesses and forge joint ventures, home health industry insiders said during a recent Home Health Care News webinar. Organic growth can mean improving conversion rates from referrals, expanding partnerships and developing operations, said Andwell Health Partners CEO Ken Albert.

Home health advocates accuse CMS of overreach on fraud-fighting measures McKnights Home Care; by Liza Berger; 7/10/26 While there has been much focus so far on the continuing behavioral adjustments in the recent home health proposed rule, there is another aspect of the rule that has drawn providers’ scorn — the harsh fraud measures. “The rule proposes significant expanded authority for CMS to deny or revoke Medicare enrollment,” Jennifer Sheets, CEO of the National Alliance for Care at Home, said during a webinar hosted by the Polsinelli law firm Thursday. “These enrollment provisions are a particular concern for us.” Sheets pointed out to a provision in the program integrity proposals that would expand the reapplication bar — prohibiting a provider from re-enrolling for up to 10 years — for any enrollment denial reason. “This really concerns us,” she said. “We think it is overreach from CMS, and that 10-year bar is a pretty scary thing to be looking at.”

CMS proposes significant changes to Medicare Provider Enrollment Mondaq | Legal500 | Intelligence; by Mary Beth Fortugno, Travis Lloyd, Julia Tamulis; 7/8/26On July 6, 2026, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would significantly expand CMS’s authority to revoke and deny Medicare enrollment and broaden disclosure obligations. Among the most significant proposals, CMS would:

CMS proposed rule: understanding palliative care in home health Hospice News; by Jim Parker; 7/10/26 While recent actions by the U.S. Centers for Medicare & Medicaid Services (CMS) could incrementally move the needle on palliative care access, they could also come with many limitations. CMS in its proposed 2027 home health rule clarified that home health providers can use certain billing codes to provide community-based palliative care to eligible patients. The agency emphasized that this palliative care would be distinct from hospice. Stakeholders in the hospice community were quick to applaud the proposal. ... However, what CMS has done falls short of a community-based palliative care benefit. For one, patients must meet the eligibility requirements for home health. This means that, among other requirements, patients must be homebound to receive this care, according to Katy Barnett, director of hospice and home health operations and policy for LeadingAge. This excludes many patients who may benefit from palliative care.

Palliative care for older adults with hip fracture: An explanatory sequential mixed-methods studyJournal of Pain & Symptom Management; by Daniel I Hoffman, Sydney Moore, Amanda J Reich, Christina Sheu, Mengyuan Ruan, Masami Tabata-Kelly, Kate Sciacca, Tamryn F Gray, Daniel Dohan, Charlotta Lindvall, Zara Cooper; 6/26After hip fracture, older adults experience burdensome treatments and high mortality; they may therefore benefit from palliative care (PC). Among 1,433 hip fracture admissions, GOCC [goals of care conversations], hospice discussions, and specialty PC were documented in view on their role in GOCC. Conclusion: Limited standardization, role uncertainty, and cultural factors limited PC documentation and delivery, highlighting opportunities to strengthen PC integration in surgical care.

What’s broken in American healthcare—and how to fix it | part one Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Dr. Don Berwick; 7/8/26What if the greatest challenge facing American healthcare isn’t a lack of innovation—but a system that rewards the wrong incentives? In this compelling new episode of TCNtalks / Anatomy of Leadership, Chris Comeaux sits down with Dr. Don Berwick—former Administrator of the Centers for Medicare & Medicaid Services (CMS), co-founder of the Institute for Healthcare Improvement (IHI), and one of the most respected voices in healthcare quality—to discuss the forces shaping healthcare today and what leaders can do to change its future.

False Claims Act insights - how hospice fraud impacts legitimate providers  Husch Blackwell LLP; by Husch Blackwell LLP; 7/6/26 Host Jonathan Porter welcomes Bryan Nowicki, leader of Husch Blackwell’s hospice practice group and host of the Hospice Insights podcast, to discuss the recent wave of hospice fraud enforcement. With hospice fraud dominating headlines in recent months, Bryan shares insights on how massive fraud schemes are impacting the industry and why legitimate providers face collateral damage.

CMS proposes expanded authority to revoke Medicare privileges TechTarget; by Jacqueline LaPointe; 7/6/26 CMS proposes expanding its authority to revoke Medicare providers in fraud crackdown, while updating home health payments with a 2.4% increase and continued PDGM adjustments. The Trump administration wants to double down on its healthcare fraud, waste and abuse crackdown. This time, policymakers are seeking to expand CMS' powers to remove providers from Medicare -- a move that the agency says will save taxpayers about $82 million a year. The added capabilities are part of the Calendar Year 2027 Home Health Prospective Payment System Proposed Rule (CMS-1844-P), which CMS released ahead of the July 4th weekend.

Medicare Advantage insurers deny prior authorization requests for post acute care at substantially higher rates than the overall denial rate KFF; by Jeannie Fuglesten Biniek, Meredith Freed, and Juliette Cubanski; 7/6/26 The OIG recently published two reports finding that Medicare Advantage insurers deny more than half of all prior authorization requests for the most expensive types of post-acute care, including 65% of requests for stays in long-term care hospitals (LTCHs) and 54% of requests for stays in inpatient rehabilitation facilities (IRFs), as well as 12% of requests for stays in skilled nursing facilities (SNFs).

Hospice in the spotlight – audits, PEPPER, and patient autonomy RACmonitor; by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 7/1/26 .. why talk hospice now? Because it seems to be hospice’s time to be in the spotlight. ... Last week you likely heard about a big U.S. Department of Justice (DOJ) $6.5 billion fraud takedown. Included in that was another hospice fraud scheme that included a funeral home employee who sold information on recently deceased people to a fraudster who then submitted claims for hospice services that were never provided. ...Then, the Centers for Medicare & Medicaid Services (CMS) has released the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for hospice organizations. And to top it off, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released an audit of hospice claims finding that Medicare paid over $255 million for patients who were not eligible for hospice care. ...

Errors in billing in the United States may result in severe civil or even criminal penalties Spilman Thomas & Battle; by Christopher R. Arthur, William S. Thompson; 7/1/26 The United States Department of Justice (DOJ) has ratcheted up its efforts to pursue actions against corporations, healthcare entities, and individuals, including physicians, for false Medicare or Medicaid billing and COVID-19-related loans. ... As part of this announcement, the Centers for Medicare and Medicaid Services (CMS) suspended 1,079 providers and revoked billing privileges for 1,403 providers. ... In addition to allowing the United States to pursue perpetrators of fraud on its own, the FCA allows private citizens to file suits on behalf of the government (called “qui tam” suits) against those who have defrauded the government. In the healthcare realm, these suits are often filed by disgruntled employees and patients, but can also be brought by competitors. ...

CMS mulls tougher Medicare enrollment rules to combat fraud as part of 2027 home health payment rule Fierce Healthcare; by Heather Landi; 7/1/26 The Centers for Medicare and Medicaid Services released on Wednesday afternoon its 2027 proposed payment rule for home health agencies. The rule includes an aggregate payment increase of $420 million, or 2.4%, based on a proposed 2.1% payment update and an estimated 0.3% increase related to the fixed dollar loss ratio. That 2.1% payment update represents $370 million, according to a CMS fact sheet. The proposal also includes updates to payment methodologies, case-mix weights, outlier payments and quality reporting requirements, while seeking feedback on expanding access to home-based palliative care. Beyond payment policy, CMS is proposing a series of anti-fraud measures that would make all Medicare enrollment revocations retroactive and broaden the agency’s authority to deny or revoke enrollment for providers and suppliers linked to compliance violations.