Literature Review

Palmetto GBA Home Health and Hospice Coalition Meeting Minutes June 16, 2025Palmetto GBA communication; 7/22/25Hosted by Tim Rogers, President and CEO, Shannon Pointer, DNP, RN, CHPN, Senior VP, Hospice and Home Health Services and Professional Development Director, AHHC of NC and SCHCHA, this meeting included questions and answers for several regulatory topics.

Be on the lookout for this new Medicare scam Las Vegas Review-Journal; by Toni King; 7/24/25 Dear Toni: A hospice agent recently came knocking on the doors in my neighborhood saying he represented Medicare. He was giving away hospice gifts and told me that I could receive these Medicare services at no charge for me and my husband. I told him that I did not give out personal information to anyone that I do not know. Now, I’m concerned that I could have made a mistake. Should I call and ask if this Medicare service is still available? —Deidre, Katy, Texas Dear Deidre: Medicare is not giving away anything free! This is a new scam that is targeting America’s Medicare population.  ...Editor's Note: Though we’ve addressed this topic repeatedly in recent months, ongoing awareness and community education remain essential. Please continue seeking opportunities to collaborate with media outlets in your service areas to help inform and protect vulnerable populations. Use the following articles—previously featured in our newsletter—as reference points:

Humana renews challenge to downgrade of US Medicare 'star' ratings Reuters; by Daniel Wiessner; 7/21/25 Humana ... filed a new lawsuit over the U.S. government's reduction in the health insurer's star ratings for government-backed Medicare plans, after an earlier challenge was dismissed on technical grounds. Humana, in the lawsuit in Fort Worth, Texas, federal court, says the lower ratings could cause it to lose customers and potentially billions of dollars in bonus payments from the government, which would have been used to reduce premiums and increase benefits for its members. U.S. District Judge Reed O'Connor in Fort Worth dismissed those claims last week, finding Humana had failed to exhaust all of its out-of-court options to challenge the ratings. In the new lawsuit, Humana says it has in recent months exhausted an administrative appeals process, giving the insurer standing to sue. 

Facing new CMS pressure, providers should audit mental health diagnoses, prescriptions: expert McKnights Long-Term Care News; by Kimberly Marselas; 7/22/25 As reported in McKnight’s Long-Term Care News on July 23, “Nursing homes should be auditing documentation for all residents with mental health disorders to ensure their diagnoses are compliant with new federal guidance, a well-known clinical reimbursement recommended Tuesday. Leigh Ann Frick, president of Care Navigation Consulting, made that suggestion while reviewing updated Long-Term Care Surveyor Guidance that went into effect in late April. At over 900 pages, the new manual and appendixes have left many providers still navigating the changes and how best to respond to them. When it comes to giving antipsychotic medications, diagnosing patients with disorders that require them, or identifying and responding to any other patient needs, the guidance puts new emphasis on the use of professional standards, Frisk explained. Guest Editor’s Note, Judi Lund Person:  For nursing home residents who have elected the Medicare hospice benefit, this information may apply. Diagnosing mental health issues, prescribing, and documenting based on professional standards is an important component in the updated Long-Term Care Surveyor guidance issued in April.

Medicare telehealth trends: Information on telehealth use by Medicare Fee-for-Service beneficiaries Data.CMS.gov; Centers for Medicaree & Medicaid Services; 7/16/25 Data update frequency: Quarterly Latest data available: Q4 2025The Medicare Telehealth Trends dataset provides information about people with Medicare who used telehealth services between January 1, 2020 and December 31, 2024. The data were used to generate the Medicare Telehealth Trends Report.

'One Big Beautiful Bill Act': Key final Medicaid changes explained Morgan Lewis; by Jeanna Palmer Gunville and Tesch Leigh West; 7/9/25 The One Big Beautiful Bill Act was signed into law on July 4 and includes significant changes to the Medicaid program, particularly with regard to state and federal financing for the program. This LawFlash provides a high-level summary of certain key provisions that will impact various Medicaid stakeholders, including states, providers, and enrollees. ...

Health care attorneys: Hospice investigations coming from all sides Hospice News; by Jim Parker; 7/8/25 Hospices are subject to a rising number of investigations and audits from Medicare contractors, the U.S. Department of Health and Human Services Office of the Inspector General and, in some cases, the U.S. Justice Department, among others. Hospices need to understand the various types of investigations they may encounter and how to respond to them. Key factors are completely and accurately documenting the medical necessity of the care they receive. Hospice News sat down with Guillermo Beades and Todd Brower, partners with the law firm Frier Levitt to discuss the ins-and-outs of hospice investigations and how providers should respond.

Two California residents plead guilty in connection with $16M hospice fraud scheme and money laundering schemeDOJ press release; 7/8/25Two California residents pleaded guilty yesterday in connection with their roles in defrauding Medicare of nearly $16 million through sham hospice companies and to laundering the proceeds of the fraud as part of a multi-year scheme. According to court documents, Karpis Srapyan, 35, of Winnetka, California, conspired with others, including co-defendants Petros Fichidzhyan and Juan Carlos Esparza, to bill Medicare for hospice services that were not medically necessary and never provided. To conduct their fraudulent scheme, they used a series of four sham hospice companies: one owned by Esparza and the other three owned by foreign nationals but controlled by the defendants. Srapyan and his co-defendants concealed the scheme by using foreign nationals’ personal identifying information to open bank accounts, submit information to Medicare, and sign property leases. They also misappropriated names and other identifying information of several doctors, two of whom were deceased, to fraudulently bill Medicare for purported hospice services. In total, Medicare paid the fake hospice companies nearly $16 million.

CMS launches new model to target wasteful, inappropriate services in original Medicare CMS Newsroom; 6/27/25 The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars. This model builds on other changes being made to prior authorization as announced by the U.S. Department of Health and Human Services and CMS on [6/23].

CMS Age-Friendly Measure: Overview for hospitals and health systems Institute for Healthcare Improvement; retrieved from the internet 7/2/25 Starting with the 2025 reporting period, hospitals will attest to providing age-friendly care through a new measure introduced by the Centers for Medicare & Medicaid Services (CMS). The CMS Age Friendly Hospital Measure advances the Age-Friendly Health Systems movement’s vision to ensure that all older adults receive age-friendly care that is evidence-based and aligns with what matters most to the older adult and their family caregivers. To date, nearly 5,000 sites of care have been recognized as Age-Friendly Health Systems — Participants and celebrated by IHI and The John A. Hartford Foundation. The measure has five domains that cover all four elements of age-friendly care, known as the 4Ms: What Matters, Medication, Mentation, and Mobility.

United Palliative & Hospice Care accused of $87M hospice scam Hospice News; by Jim Parker; 7/2/25 Three women associated with Houston-based United Hospice & Palliative Care (UPHC) have been charged with Medicaid and Medicare fraud after allegedly bilking more than $87 million in federal health care funds. The trio includes UPHC owner Dera Ogudo, an UPHC employee Victoria Martinez and a psychiatric hospital employee, Evelyn Shaw, ABC-13 Houston reported. The prosecutor’s indictment also includes an unnamed physician who allegedly received kickbacks for referrals to UPHC. “Ogudo and her co-conspirators preyed on the vulnerable residents of those group homes by enrolling them in hospice services with UPHC when they were not terminally ill,” the indictment indicated.

CMS to test prior authorization model in traditional Medicare MedPageToday; by Joyce Frieden; 6/30/25 The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model late last week to streamline some prior authorizations under the traditional Medicare program, but some politicians and experts are concerned that it could result in more delays in care. Under the model, known as the Wasteful and Inappropriate Service Reduction (WISeR) Model, "CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process" under traditional Medicare, the agency said Friday [6/27] in a press release ...