Literature Review

Hawai'i Attorney General rejects characterization of Medicaid fraud enforcement and defends state's enforcement record Hawai'i Free Press, Honolulu, HI; by News Release from Department of the Attorney General; 5/14/26The Department of the Attorney General today rejected recent claims that Hawaiʻi “isn’t taking Medicaid fraud seriously,” calling the claims by Vice President J.D. Vance false and unsupported by the record. Since 2021, the Medicaid Fraud Control Unit (MFCU) has secured or helped secure judgments, settlements and recoveries in 25 cases, totaling $14,094,547.91. Last year, the MFCU secured a $30,000 settlement against a Medicaid provider for fraudulent billing. Earlier this year, the MFCU secured another Medicaid fraud settlement in the amount of $208,317.69. The MFCU also filed criminal charges earlier this year against two individuals, one of whom has already pleaded no contest as charged. [Hawai'i Medicaid Fact Sheet] Editor's Note: This article references "Hawaii's Medicaid coverage for palliative care expected to save the state money," which describes, "Hawaii is the first state to include palliative care in its Medicaid plan."

Moratorium a ‘sledgehammer’ approach in hospice fraud forcefield Hospice News; by Holly Vossel; 5/14/26 A temporary national moratorium has halted new hospice and home health enrollment in an effort to curb fraudulent activity in these industries. The hospice community has come forward in droves to examine the scope of potential benefits, and risks, to future access and quality. ... Applying a broad brush of regulatory enforcement could come with unintended challenges for legitimate providers, which represent the vast majority of hospices.

JD Supra: CMS Nationwide Moratoria for new hospice and home health enrollments JD Supra; by Andrew Brenton, Zaina Niles, Bryan Nowicki, Adam Royal, Husch Blackwell LLP; 5/14/26 ... The Husch Blackwell Hospice & Palliative Care team is continuing to evaluate the full implications, scope, and effect of the moratoria, but here are a few key takeaways for providers:

CMS leader explains hospice fraud, Medicare risks, and the future of healthcare | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Kim Brandt; 5/13/26 In this compelling first installment, CMS Chief Operating Officer and Deputy Administrator Kim Brandt joins Chris Comeaux for a candid conversation about the growing hospice fraud crisis, the financial future of Medicare, and the urgent transformation happening across American healthcare. Drawing from her leadership role at CMS and firsthand experiences with hospice care in her own family, Brandt shares why hospice remains a critical pillar of compassionate care — while also exposing the alarming abuse threatening the integrity of the system.

CMS leader explains hospice fraud, Medicare risks, and the future of healthcare | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Kim Brandt; 5/13/26 In this compelling first installment, CMS Chief Operating Officer and Deputy Administrator Kim Brandt joins Chris Comeaux for a candid conversation about the growing hospice fraud crisis, the financial future of Medicare, and the urgent transformation happening across American healthcare. Drawing from her leadership role at CMS and firsthand experiences with hospice care in her own family, Brandt shares why hospice remains a critical pillar of compassionate care — while also exposing the alarming abuse threatening the integrity of the system.

The Alliance responds to CMS’s announcement of nationwide enrollment moratoria on hospice and home health providers  National Alliance for Care at Home | The Alliance; Press Release; 5/13/26 On May 13, the Centers for Medicare & Medicaid Services (CMS) announced a six-month national moratorium on hospice and home health enrollment in response to program integrity concerns within the Medicare programs. While the National Alliance for Care at Home (the Alliance) strongly supports efforts to root out bad actors who exploit these essential programs, undermine confidence in care at home, and threaten the patients and families who depend on it, the Alliance has long advocated for targeted strategies that distinguish between high-fraud markets and communities where fraud is not an identified problem and patients already face shortages of providers. 

Watch recording: JD Vance holds press conference on anti-fraud initiatives Washington Examiner | White House | YouTube | PBS News; by David Zimmermann; 5/13/26 Vice President JD Vance held a press conference Wednesday afternoon on anti-fraud initiatives he has been spearheading alongside other officials. Since March, the vice president has led the White House task force designed to combat fraud across the nation. Reported fraud in Minnesota served as the impetus for the task force’s creation, according to an executive order. 

DOJ doubles down on healthcare fraud enforcement with new West Coast strike force MedCity News; by Katie Adams; 5/10/26 ... The DOJ rolled out a strike force targeting healthcare fraud in Arizona, Nevada and Northern California. The new strike force — which the DOJ is calling its “West Coast” healthcare fraud strike force — comes seven months after the department launched a similar strike force going after healthcare fraud in Massachusetts. Florida is not on this list yet, even though it has a reputation for healthcare fraud, but it might be next. 

HOPE is raising the stakes for hospice compliance HealthIT Answers; by Michelle Barlow, RN, BSN; 5/11/26 Hospice providers are entering a tougher regulatory environment. ... At the center of these changes is the Hospice Outcomes and Patient Evaluation (HOPE) tool, which replaced the Hospice Item Set in October 2025. ...

Healthcare leaders break down hospice reform, Medicare & quality care | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Tom Koutsoumpas and Carole Fisher; 5/6/26 In Part One of Healthcare Leaders Break Down Hospice Reform, Medicare & Quality Care, Chris Comeaux sits down with nationally respected healthcare leaders Tom Koutsoumpas, Founder & CEO of NPHI and Carole Fisher, President of NPHI to explore the evolving future of hospice, palliative care, Medicare oversight, and the growing demand for quality-driven, compassionate healthcare leadership. Together, they unpack the growing challenges facing end-of-life care — from fraud and benefit manipulation to the urgent need for quality transparency and authentic patient-centered care.

CMS posts information on hospice election notification pilot: Crushing fraud, waste, & abuseCMS.gov; 5/1/26 On April 30, 2026, CMS announced that they had expanded the Hospice Election Notification pilot from Nevada into California.  During the pilot, when a hospice provider files a Notice of Election, a notification letter is immediately sent to the beneficiary to make sure they know they have been enrolled in hospice. If they did not enroll, they are instructed to call 1-800-MEDICARE who can help with overturning the election. Since the start of the pilot in Nevada in May 2025, more than 25,000 letters have been issued.  A copy of the letter being sent to beneficiaries in these states is available here.

Empower Oversight widens state fraud queries to New York Hospice Regulator Empower Oversight Whistleblowers & Research, Washington, DC; Press Release; 5/1/26 Empower Oversight has filed a public records request with New York’s Center for Hospice and Palliative Care, the state agency responsible for regulating the hospice industry, as part of its broader investigation into fraud involving federal taxpayer funds. The request seeks documents that shed light on potential systemic failures in hospice oversight, and on how the agency has identified, responded to, or declined to act on known fraud indicators. ... For a copy of the letter click here.

Alliance sounds alarm over federal payment suspensions tactic to fight hospice fraud McKnights Home Care; by Liza Berger; 5/1/26 As the federal government continues to crack down on rampant hospice fraud in California and other states, advocates for the field fear that the government’s latest enforcement effort is unintentionally trapping ethical providers. ... While the government is basing a payment suspension on “a credible allegation of fraud,” the National Alliance for Care at Home worries that the government is using just one metric to justify its “credible allegation.” ... In a post this week, law firm Foley & Lardner LLP CMS defined a “’credible allegation of fraud’ as an allegation of fraud from any source, including but not limited to the following: (1) fraud hotline tips ... verified by further evidence; (2) claims data mining; and (3) patterns identified through provider audits, FCA cases and investigations.”