Literature Review

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. ...

Vance’s fraud task force is sweeping up legitimate small businesses The Washington Post, Washington, DC; by Isaac Arnsdorf; 6/15/26 The vice president and other officials have downplayed evidence of collateral damage in their crackdown on fraudulent hospices. In April, when the Trump administration began suspending about 800 hospices in the Los Angeles area suspected of fraud, a small local agency started accepting patients from the affected providers. The owner never thought he would be next. ... “The Trump administration is taking a pretty aggressive tactic here, but the downside is you’re often going to catch up legitimate actors because you’re not really taking the time to do your due diligence,” said Hillary Loeffler, vice president of policy and regulatory affairs for the National Alliance for Care at Home, an industry group, who worked on hospice issues at CMS until 2025.

CMS moratorium could spur hospice, home health M&A Hospice News; by Jim Parker; 6/12/26 A current moratorium on home health and hospice Medicare enrollment could increase demand for mergers and acquisitions in the short term. ... The pause is intended to address concerns about a surge in new providers that regulators have linked to fraudulent activity in the hospice sector. ... Rumors have circulated that the moratorium could be extended beyond the six months, though to date CMS has given no indication that will be the case. The moratorium could limit provider growth via de novos, so some companies may turn towards more M&A, according to Cory Mertz, managing partner of the M&A advisory firm Mertz Taggart.

CMS home health and hospice moratoria update: emerging guidance and enforcement update JD Supra; by Christina Bergeron, Lauren Biggs, Robin Briendel; 6/10/26 This Alert discusses [developments since the May 13th CMS home health and hospice moratoria], as well as related state Medicaid and licensure activity, increasing enforcement activity, and recent federal legislative developments affecting the hospice and HHA sectors.

California 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.

VITAS CEO: CMS’ national moratorium disappointing Hospice News; by Jim Parker; 6/5/26 The U.S. Centers for Medicare & Medicaid Services’ (CMS) national moratorium on home health and hospice enrollment is “disappointing,” according to VITAS Healthcare CEO Joel Wherley. ... “Our stance and position in working with [CMS Administrator] Dr. Oz and their group is that we are extremely supportive,” VITAS CEO Joel Wherley said at the RBC Capital Markets Global Healthcare Conference. “What we are disappointed in is the broad brush approach they decided to take nationally in announcing the hospice moratorium. We would much more prefer a targeted specific approach where they’ve identified areas of fraud and work specifically then with local and state governments to weed out that fraud.”

LA County fraud: Why hospice care became the new target Film Daily; by Simone Barbon; 6/3/26 Los Angeles County has become the focal point of multiple federal, state, and local actions against hospice fraud schemes that target Medicare and Medi-Cal. The concentration of facilities, unusual billing patterns, and recent arrests explain why regulators treat the county as ground zero. ... Data shows unusual density. Records reviewed by CBS News found roughly 1,800 hospices operating in Los Angeles County. More than 700 of them triggered multiple state fraud indicators. One stretch of Victory Boulevard contained nearly 500 hospices within three miles, and a single building listed 89 separate companies. Typical facilities in the county billed Medicare about $29,000 per patient. The national average sits at $13,200. That gap prompted auditors to flag the region years before arrests began.Editor's Note: This article describes complex factors of the hospice fraud crisis with clarity for the general public.

Medicare 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. ...

Hospice 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.

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.

CMS crackdown upends hospice dealmaking Holland & Knight; by Law360; 6/2/26 Healthcare attorney Michelle Huntsman was quoted in a Law360 article examining how the federal government's moratorium on new Medicare enrollments in the home health and hospice care industry will affect dealmaking and private equity strategy. ... Ms. Huntsman cautioned to anticipate more detailed legal reviews from transactional attorneys and tougher enforcement from regulators. These steps will increase the timeline for deal flow, she added, but activity will not cease altogether.

Ohio 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.