Literature Review

Hundreds including Iowans implicated in $6.5B health care fraud schemes Ames Tribune, Des Moines, IO; by Natalie Neysa Alund and William Morris, USA TODAY; 6/25/26 Hundreds of people and organizations, including several in Iowa, have been charged in connection with global health care fraud schemes totaling a record $6.5 billion, the U.S. Department of Justice says. ... Three of the cases were in Iowa. The largest involves Mercy Health Network, Genesis Health System and Trinity Health Corp., which operate the MercyOne Genesis system based in Davenport. According to the news release, the partners self-reported overuse and overbilling for a specialty heart pump from 2016 to 2022, and agreed to pay more than $4.6 million to the government. ... And prosecutors are criminally charging Jacob Hughes of Cedar Rapids and Hughes Home Care, which did business as Synergy Homecare.

National health care fraud takedown results in 455 defendants charged in connection with over $6.5 billion in alleged fraud Office of Public Affairs - U.S. Department of Justice, Washington, DC; Press Release; 6/23/26Record Medicaid Fraud Charges Largest Number of States Participating in Health Care Fraud Takedown History: The Justice Department today announced the 2026 National Health Care Fraud Takedown, which resulted in charges against 455 defendants, including 90 doctors and other licensed medical professionals, for their alleged participation in health care fraud and opioid abuse schemes involving over $6.5 billion in false claims and significant patient harm, including death. Today’s Takedown represents a new era in federal, state, and international cooperation to combat health care fraud: cases in 56 federal districts and 45 U.S. states and territories, with 50 state Medicaid Fraud Control Units participating, the most in Department history.

Federal investigation into Medicare fraud snares Corona man Patch, Los Angeles, CA; by Toni McAllister; 6/23/26 Abraham Shin, 66, and two other people are charged in a 16-count indictment alleging they conspired to defraud Medicare out of $27 million. ...  According to the indictment, from February 2021 to March 2026, Oren David Shachar, 59, of Van Nuys — who owned and operated at least four hospice care companies — conspired with marketers Shin, and Jeannie Choi, 57, of Torrance. As part of the alleged fraudulent operation, claims for hospice services were submitted to Medicare that were medically unnecessary because the beneficiaries were not terminally ill, or the services were not provided because the beneficiaries were already dead, according to the indictment.

Medicare could have saved $255.1 Million related to hospice services for certain new hospice enrollees United States Government HHS-Office of the Inspector General (OIG), Report number: A-06-22-09003; issued on 6/18/2026, posted on 6/23/26 [From the Full Report]: Our objective was to determine whether the Centers for Medicare & Medicaid Services (CMS) made Medicare payments to hospices for certain new hospice enrollees in accordance with Medicare requirements.

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.”