Literature Review

Vance to lead sweeping anti-fraud task force investigating California Before It's News; Press Release; 2/4/26 Vice President JD Vance is poised to chair a new White House task force aimed at rooting out potential fraud and abuse in government programs in California, according to CBS News. Andrew Ferguson, chairman of the Federal Trade Commission, is expected to serve as the task force’s vice chairman and handle day-to-day operations, CBS News reports. President Donald Trump is anticipated to issue an executive order in the coming days to formally establish the group, the news outlet said.

Congressional hearing confronts hospice, health care fraud Hospice News; by Jim Parker; 2/4/26 Regulatory reform, better data and more state-federal and other stakeholder partnerships are necessary to combat health care fraud in the United States, including among hospices. This was a key message in a recent hearing by the House Energy and Commerce Subcommittee on Oversight and Investigations. Hospice fraud has been rampant in certain states. Unscrupulous providers have enrolled patients in hospice who were not eligible or without their knowledge or consent. They have also transferred patients from one hospice to another in exchange for monetary payments, engaged in “license flipping,” and paid illegal kickbacks for referrals, among other abuses.

Hospice regulatory 2025 updates- year-end overview The National Law Review; by Benjamin J. Fenton, Nick D. Jurkowitz, Much Shelist, P.C.; 2/3/26 As 2025 comes to an end, many hospice-related regulatory changes from the start of the fiscal year are now in effect and actively shaping daily operations. Providers nationwide have spent the year changing workflows, training staff, and improving infrastructure to remain compliant. 2025 Hospice Regulatory Updates:

From new division to new leadership: White House appoints national “Fraud Czar” Benesch; by Robert J. Kolansky, Pilar G. Mendez, Briana Cowman; 1/30/26  The White House has announced the creation of a new senior enforcement role focused on identifying, coordinating and advancing large-scale fraud matters across federal programs and the private sector, signaling a renewed emphasis on centralized fraud enforcement strategy rather than a shift in underlying legal standards. According to recent reporting, the Administration has appointed a seasoned investigator and prosecutor, Colin McDonald to serve in this newly created role, informally described as a national “fraud czar.” 

False Claims Act 2025 year-end update Gibson, Dunn & Crutcher; Press Release; 1/27/26 This update covers recent developments in FCA jurisprudence, summarizes significant enforcement activity, and analyzes the most notable legislative, policy, and caselaw developments from the second half of calendar year 2025, picking up where our mid-year 2025 update left off.

Woman faked can­cer, death to get out of court cases, DA says The Boston Globe; by Tonya Alanez; 1/24/26 A Ply­mouth woman who allegedly pre­ten­ded to have ter­minal brain can­cer to get out of numer­ous court cases, and even fab­ric­ated her death, is facing numer­ous charges related to the obstruc­tion scheme, pro­sec­utors said Thursday. Shan­non E. Wilson had sev­eral crim­inal cases pending in Mas­sachu­setts dis­trict courts dur­ing 2022 and 2023, accord­ing to a state­ment from the office of Ply­mouth Dis­trict Attor­ney Timothy J. Cruz. “Dur­ing the pen­dency of those pro­ceed­ings, wilson allegedly rep­res­en­ted — both per­son­ally and through defense coun­sel — that she was suf­fer­ing from ter­minal can­cer, was under­go­ing treat­ment, had entered hos­pice care, and ulti­mately had died," Cruz’s state­ment said. 

2026 health care fraud year in preview Foley Hoag LLP - White Collar Law & Investigations; by Foley Hoag LLP; 1/16/26 ... As in years past, the investigation and prosecution of health care fraud cases remains at the forefront of the federal government’s enforcement activity, though tempered by the government’s interest in a variety of non-health care enforcement, some of which we take up in forthcoming entries in our Year in Preview series. 

Increased criminal and civil enforcement by DOJ for skin substitutes in wound care JD Supra; by Tanisha Palvia, Jenn Sugar, Moore & Van Allen PLLC; 1/15/26 The Department of Justice recently announced, “[i]n the first [criminal] prosecution of its kind,” that husband and wife owners of wound graft companies were sentenced to 14.5 and 15 years imprisonment respectively for causing over $1.2 billion in false claims to be submitted to Medicare Part B and other federal health care programs for medically unnecessary wound grafts. ... The massive scheme had medically untrained sales representatives find elderly Medicare beneficiaries, often in hospice care, with any kind of wound.

CMS expands PPEO and EPR to Georgia and Ohio JD Supra; by Bryan Nowicki; 1/8/2026 CMS has extended its Provisional Period of Enhanced Oversight (PPEO) and its Expanded Prepayment Review (EPR) enforcement efforts to Georgia and Ohio. The enhanced enforcement efforts can lead to the revocation of a hospice’s Medicare billing privileges, termination of Medicare/Medicaid enrollment, and/or the prepayment review of 100% of a hospice’s claims. VERY Brief PPEO/EPR Overview: CMS’s process relating to these efforts is quite inconsistent, but generally . . .

NPHI welcomes CMS leaders Dr. Mehmet Oz, Kimberly Brandt, and Chris Klomp for on-the-ground listening tour at Nathan Adelson HospiceNational Partnership for Healthcare and Hospice Innnovation (NPHI), Washington, DC; Press Release; 1/9/26 The National Partnership for Healthcare and Hospice Innovation (NPHI) welcomed leadership from the Centers for Medicare & Medicaid Services (CMS) on Thursday to Nathan Adelson Hospice, Las Vegas, as part of an on-the-ground listening tour focused on hospice program integrity and the real-world challenges facing patients, families, and nonprofit providers. As part of the visit, Dr. Mehmet Oz, Administrator of CMS, Kimberly Brandt, CMS Chief Operating Officer, and Chris Klomp, Director of the Center for Medicare met with hospice clinicians, staff, community stakeholders, and NPHI leadership to hear local patient and provider stories that illustrate broader national concerns related to fraud, waste, and abuse in hospice care.

NPHI organizes listening tour on hospice program integrity with CMS leaders Dr. Oz and Kim BrandtNational Partnership for Healthcare and Hospice Innovation (NPHI); Press Release; 1/8/26On Thursday [1/9], Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), and Kim Brandt, CMS Chief Operating Officer ... are visiting Nathan Adelson Hospice in Las Vegas as part of a listening session and on-site tour. On Friday, the tour continues in California, where NPHI is supporting discussions with federal leaders and providers in the state focused on fraud and abuse challenges impacting hospice care. These conversations are intended to help federal leaders better understand what providers are seeing on the ground and explore how CMS and the provider community can work together to strengthen program integrity while protecting access to high-quality, mission-driven care.

Medicaid agencies made millions in unallowable capitation payments to managed care organizations on behalf of deceased enrolleesOIG press release; 12/23/25A new OIG audit found that from July 2021 to June 2022, state Medicaid programs made an estimated $207.5 million in capitation payments to managed care organizations for enrollees who were already deceased. This estimate is based on the results of our review of 100 statistically sampled capitation payments. We determined that Medicaid agencies made unallowable capitation payments after enrollees’ deaths for 99 of the 100 sample capitation payments.

Maryland acts after Spotlight ‘trafficking’ probe: Seniors removed, criminal referral filedBaltimore Sun; by Gary Collins; 12/3/25...Maryland officials were taking action following a Spotlight on Maryland investigation found more than 115 suspected unlicensed assisted living facilities were operating across Baltimore, some with little oversight, few inspections and no trained medical staff to attend the seniors housed there.