Literature Review

All posts tagged with “Regulatory News | Fraud & Abuse News.”



Maui Hospice calms jitters after feds freeze new Medicare sign-ups

05/22/26 at 02:00 AM

Maui Hospice calms jitters after feds freeze new Medicare sign-ups Hoodline; by Marc Suzuki; 5/20/26Hospice Maui moved quickly this week to calm worried island families after federal officials hit pause on new Medicare hospice and home health enrollments. The Wailuku nonprofit stressed that long-standing, Medicare-certified providers like itself are not the focus of the federal action, and that patients already in its care will continue to receive visits, medications and support services without interruption. The organization also pointed families to a direct phone line for anyone who wants a real person to walk them through what the freeze does and does not mean.

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Background on CMS’s anti-fraud efforts in hospice care

05/22/26 at 02:00 AM

Background on CMS’s anti-fraud efforts in hospice careAEI - The American Enterprise Institute; by James C. Capretta; 5/21/26 ... For broader context, Congress added hospice coverage to Medicare in the 1980s to provide lower-cost and more patient-centered settings for terminally ill beneficiaries. ... Like home health, the hospice benefit is vulnerable to abuse because the barriers to entering the market are lower than in more regulated settings. The capital investment to get started is minimal in comparison with building a new hospital, outpatient clinic, or nursing home. Further, the potential profit margins are high if a service provider is confident that the per diem is above what is needed to provide the required services.Although CMS’s focus on fraud in hospice care is warranted, stronger oversight by itself may not produce large program savings. In theory, more use of hospice care could lead to lower overall costs if the sponsoring agencies are competent and can help their patients avoid costly hospital or nursing home admissions. CMS’s investigations need to be subtle enough to weed out the bad actors without making it overly difficult for vulnerable patients to get the care they need in their own homes or in other low-cost community settings.

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HealthView CEO Steven Gonzalez announces Inc. articles on why presence beats certainty — and why it matters even more in the age of AI

05/21/26 at 03:00 AM

HealthView CEO Steven Gonzalez announces Inc. articles on why presence beats certainty — and why it matters even more in the age of AI Associated Press, Cerritos, CA; 5/19/26 Steven Gonzalez, President & CEO of HealthView Home Health, Hospice & Palliative Care, announces the publication of his latest Inc. article, “Certainty Is Overrated. Presence Is Underrated,” now live on Inc.com. ... In the published article, Gonzalez challenges a long-held leadership myth: that strong leaders must always project confidence, clarity, and absolute answers. Instead, he makes the case that presence, consistency, and authenticity matter more than false certainty in times of rapid change. When leaders remain visible, grounded, and human, they build the trust and stability that carry teams forward — even in the middle of ambiguity.

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CMS’s nationwide moratorium on new hospice and home health enrollments: operational, transactional, and enforcement risks for existing providers, healthcare organizations, and investors

05/21/26 at 03:00 AM

CMS’s nationwide moratorium on new hospice and home health enrollments: operational, transactional, and enforcement risks for existing providers, healthcare organizations, and investorsClark Hill; by Jose Vela Jr.; 5/19/26 ... Key Takeaway: The larger issue may no longer be whether fraud exists within isolated hospice or home health agencies. ... Healthcare organizations, investors, healthcare professionals, and operational leaders affiliated with hospice and home health providers may wish to evaluate ownership structures, pending transactions, enrollment status, billing practices, referral relationships, operational controls, reimbursement exposure, and existing government scrutiny before operational disruptions, payment suspensions, recoupment activity, or enforcement actions arise.

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Loving Hands Hospice challenges Medicare payment suspension, cites due process concerns amid California hospice enforcement actions

05/21/26 at 03:00 AM

Loving Hands Hospice challenges Medicare payment suspension, cites due process concerns amid California hospice enforcement actions TMX Newsfile | Newsfile Corp., Los Angeles, CA; Press Release; 5/19/26 Loving Hands Hospice, a women-owned hospice care provider based in Los Angeles, California, has announced that it is currently involved in a legal dispute connected to Medicare payment suspension measures and related allegations under review (Reference Number: PSP-260330-00042). ... Loving Hands Hospice, which has provided hospice services to patients and families in the Los Angeles area for approximately five years, says it supports enforcement actions where legitimate fraud is identified. However, company leadership states that broad enforcement measures applied across California's hospice sector may not adequately account for differences in individual provider circumstances, patient populations, and compliance histories.

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Addus HomeCare says license moratorium won’t slow personal care growth, M&A

05/21/26 at 03:00 AM

Addus HomeCare says license moratorium won’t slow personal care growth, M&A Transcript Daily; by Lauren Steadman; 5/19/26 Addus HomeCare (NASDAQ:ADUS) executives said a new federal moratorium on certain home health licenses should have little effect on the company’s growth plans, while highlighting continued improvement in personal care services trends and ongoing acquisition opportunities.

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Paul Ledford: Program integrity should strengthen — not undermine — access to hospice care in Florida

05/21/26 at 02:00 AM

Paul Ledford: Program integrity should strengthen — not undermine — access to hospice care in Florida Florida Politics; by guest author Paul Ledford, president and CEO of the Florida Hospice & Palliative Care Association; 5/18/26 Few places in America are as closely tied to retirement and aging as Florida. [Background information on the recent CMS Hospice and Home Health Moratorium] ... CMS has previously acknowledged that targeted, geographically focused enforcement is the most effective way to combat localized fraud. A nationwide moratorium contradicts that approach. Rather than protecting patients, it risks cutting off access for the very people hospice is designed to serve. The right solution is targeted enforcement — cracking down on criminal networks in the specific communities where abuse is documented, without penalizing high-performing states and the families who rely on their care.

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Hawai'i Attorney General rejects characterization of Medicaid fraud enforcement and defends state's enforcement record

05/19/26 at 03:00 AM

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."

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Home health & hospice M&A in 2026: how compliance and clinical risk affect valuation and deal structure

05/19/26 at 03:00 AM

Home health & hospice M&A in 2026: how compliance and clinical risk affect valuation and deal structure JD Supra; by Arnall Golden Gregory, LLP; 5/15/26 Key Takeaways:

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Moratorium a ‘sledgehammer’ approach in hospice fraud forcefield

05/18/26 at 03:00 AM

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.

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Ohio taking new steps to target Medicaid fraud

05/18/26 at 03:00 AM

Ohio taking new steps to target Medicaid fraud Spectrum News 1, Cleveland and Columbus, OH; by Aliah Keller; 5/14/26Ohio is taking new steps to crack down on Medicaid fraud, with a focus on home-healthcare and hospice providers.What You Need To Know

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JD Supra: CMS Nationwide Moratoria for new hospice and home health enrollments

05/18/26 at 02:30 AM

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:

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The National Law Review: CMS imposes nationwide enrollment moratoria on hospices and home health agencies - what buyers sellers and operators need to know

05/18/26 at 02:15 AM

The National Law Review: CMS imposes nationwide enrollment moratoria on hospices and home health agencies - what buyers sellers and operators need to know The National Law Review; by Margia Corner, Ashley Wheelock, Tammy Ward Woffenden, Sheppard, Mullin, Richter & Hampton LLP; 5/14/26 ... [Assuming readers have background information] ... Critically for some pending or proposed transactions, both moratoria block re-enrollment of hospices or HHAs undergoing a non-exempt change in majority ownership (CIMO) within 36 months of initial enrollment or the most recent CIMO. Such transactions require the entity to enroll as a brand-new provider.... Both moratoria apply only to Medicare. However, CMS is encouraging states to consider parallel moratoria for Medicaid and CHIP, tailored to their beneficiary population and geographic considerations. CMS also noted that while some states previously enacted laws placing a moratorium on issuing new licenses in their state, those efforts cannot prevent new agencies or enrollments in other states and thus its nationwide moratoria are warranted.

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CMS leader explains hospice fraud, Medicare risks, and the future of healthcare | part two

05/18/26 at 02:00 AM

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.

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FOR YOU - Free webinar today by CHAP, 3-4pm ET: The National Hospice and Home Health Enrollment Moratorium | What we know so far

05/15/26 at 02:00 AM

Free webinar today by CHAP, 3-4pm ET: The National Hospice and Home Health Enrollment Moratorium | what we know so far Community Health Accreditation Partner; webinar will be presented by Kim Skehan, Jennifer Kennedy, and Teresa Harbour; posted 5/14/26 with webinar 5/15/26 Join CHAP and Kim Skehan for a timely discussion focused on what we currently know, what remains unclear, and how providers should be thinking about readiness, compliance, and next steps. Anyone can view and join online. During the webinar, we will cover:

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CMS leader explains hospice fraud, Medicare risks, and the future of healthcare | part one

05/14/26 at 03:15 AM

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.

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CMS announces aggressive nationwide crackdown on fraud with six-month hospice and home health agency enrollment moratoria

05/14/26 at 03:00 AM

US halting Medicare enrollments for new home healthcare and hospice providers Reuters; by Jody Godoy; 5/13/26 The Trump administration will temporarily block new home health and hospice providers on Wednesday from enrolling in Medicare, a senior administration official said, citing concerns about widespread fraud. The nationwide moratorium is the latest move by Vice President JD Vance's anti-fraud task force to crack down on healthcare scams, including those that affect Medicare, a U.S. government program providing health insurance to elderly and disabled Americans.

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The Alliance responds to CMS’s announcement of nationwide enrollment moratoria on hospice and home health providers

05/14/26 at 03:00 AM

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. 

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Hospice fraud is becoming a political flashpoint. Why?

05/14/26 at 03:00 AM

Hospice fraud is becoming a political flashpoint. Why? National Public Radio WAMU; by Michelle Harven; 5/11/26 The state of California recently charged 21 people with hospice fraud, accusing them of costing the state $267 million. These types of schemes start with criminals opening up shell companies, signing recipients up without their knowledge, and then billing Medi-Cal for nonexistent services. This can have a serious effect on a senior’s ability to find care in the future. And it’s not just a state matter. The push to uncover this kind of fraud has become a political battle ... We sit down and talk about why we’re seeing this kind of fraud happen, who it harms, and why it’s become a political flashpoint.

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Watch recording: JD Vance holds press conference on anti-fraud initiatives

05/14/26 at 01:00 AM

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. 

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BREAKING NEWS: CMS announces aggressive nationwide crackdown on fraud with six-month hospice and home health agency enrollment moratoria

05/13/26 at 08:00 AM

US halting Medicare enrollments for new home healthcare and hospice providers Reuters; by Jody Godoy; 5/13/26 The Trump administration will temporarily block new home health and hospice providers on Wednesday from enrolling in Medicare, a senior administration official said, citing concerns about widespread fraud. The nationwide moratorium is the latest move by Vice President JD Vance's anti-fraud task force to crack down on healthcare scams, including those that affect Medicare, a U.S. government program providing health insurance to elderly and disabled Americans.

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We can fight fraud without threatening access to care

05/13/26 at 03:00 AM

We can fight fraud without threatening access to care RealClear Health; by Peter Pitts; 5/8/26 ... In recent months, the Trump administration has identified a small but significant number of bad actors that have cheated the system. These fraudsters aren’t just stealing taxpayer dollars — their actions are threatening access to quality care and undermining patients and families’ trust in Medicare. Those criminals should be removed from federal programs and prosecuted. ... But that’s not the full story. Not even close. ... This doesn’t have to be a choice between fighting fraud and protecting access to care. We can and must do both: root out fraud and protect access to high-quality hospice and home health care at the same time.

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DOJ doubles down on healthcare fraud enforcement with new West Coast strike force

05/13/26 at 03:00 AM

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. 

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HOPE is raising the stakes for hospice compliance

05/12/26 at 03:00 AM

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. ...

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Local hospice leader exposes fraud draining millions in taxpayer dollars across Texas

05/12/26 at 03:00 AM

Local hospice leader exposes fraud draining millions in taxpayer dollars across Texas KWTX 10, Waco, TX; by Nicole Marino; 5/8/26 Texas hospice licenses have nearly doubled since 2020, with some operators billing Medicare for patients who don’t know they’re enrolled. ... Lisa McNair, president and CEO of Hospice Brazos Valley, testified before the Texas Senate Committee on Health and Human Services in April with research showing the number of hospices in Texas has nearly doubled since 2020. There are now more than 1,300 hospices operating in the state. ... McNair told KBTX that the fraud is draining taxpayer dollars and eroding trust in legitimate end-of-life care.

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