Literature Review

DOJ uncovers $6.5 billion healthcare fraud and charges record 455 defendants Washington Examiner; podcast by Kaelan Deese; 6/23/26 A nationwide healthcare fraud crackdown resulted in charges against 455 defendants accused of schemes involving more than $6.5 billion in fraudulent claims, marking what federal officials on Tuesday described as the largest coordinated healthcare fraud enforcement action in Justice Department history. Acting Attorney General Todd Blanche, Health and Human Services Secretary Robert F. Kennedy Jr., FBI Director Kash Patel, and Centers for Medicare & Medicaid Services Administrator Mehmet Oz announced the operation, which spanned 57 federal districts across 41 states and territories and included charges against 90 licensed medical professionals.

A smarter approach to fraud means better care at home The Hill | Opinion; by Rep. Beth Van Duyne (R-Texas) and Jennifer Sheets; 6/23/26 .. Home health and hospice providers meet people where they are — both physically and through wraparound support — caring for them in their homes at the end of life or during critical healing and recovery periods when trust is paramount. ... Fraudulent operators do not simply steal taxpayer dollars; they harm real people, exploit vulnerable individuals, undermine legitimate providers, and erode confidence in critical healthcare services that families depend on every day. Combatting fraud, waste and abuse in healthcare must remain a national priority. That is why I am glad to partner with the National Alliance for Care at Home on the Protecting Seniors and Stopping Fraudsters Act, designed to strengthen program integrity in home health and hospice while protecting access to care for patients who depend on these services, and reducing burden for legitimate providers.

Somerset hospice opening delayed by Medicare move The Tribune-Democrat, Somerset, PA; by Kelly Urban; 6/20/26 Following a ribbon-cutting in May for the reopening of the Somerset inpatient hospice facility, Windber Hospice at Chan Soon-Shiong Medical Center at Windber has provided an update regarding the facility’s opening timeline. While the facility remains on track to reopen, the opening has been delayed by a recently announced nationwide Medicare enrollment moratorium affecting new hospice enrollments and hospice locations. ... “We know many families have been eagerly anticipating the return of inpatient hospice care in Somerset County, and we share their disappointment in this unexpected delay,” said Richard Sukenik, CEO of Chan Soon-Shiong Medical Center at Windber. “We are actively working with local, state and federal legislators to seek assistance and ensure they understand the importance of bringing this service back to Somerset County. We will continue pursuing every available avenue to move this project forward while preparing to welcome patients as soon as approval is granted.” [Access to the full article may be limited by a paywall.]

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. ...

LA City fraud: How many millions has the county lost? FilmDaily; by Simone Barbon; 6/15/26 Los Angeles County continues to tally losses from multiple fraud schemes that targeted public funds during and after the pandemic. Taxpayers want concrete numbers on how much money disappeared and whether recent prosecutions are closing the gaps. 

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.

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.

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.