by Tim Rowan, Editor Emeritus
Formal NGS Complaint Submitted to OIG
Hospice Wrongly Subjected to PPEO Fights Back
Two weeks ago, we reported on an Arizona hospice that found itself in the middle of a revalidation survey when its Medicare Administration Contractor incorrectly classified it as a new provider. NGS placed the hospice under Provisional Period of Enhanced Oversight (PPEO) and promptly terminated its owners following a separate, 10-claim audit. (See “NGS Shutters Valid Hospice” – July 17)
According to this hospice’s PECOS file, no change of ownership — or any other triggering event that would justify reclassification — ever occurred. The error led to a clinical review of a handful of claims, a determination of fraudulent billing, and a 10-year ban against the owners.
On Monday, July 27, the hospice submitted a formal complaint to the Office of the Inspector General at HHS regarding NGS practices. According to the Medicare consultant retained by the hospice, the formal referral became necessary after a letter to CMS Administrator Dr. Mehmet Oz, describing multiple missteps by NGS, went unanswered. A subsequent video meeting with low-level CMS staff resulted only in a defense of the contractor.
Executive Summary
The hospice allowed us to publish a general summary of the complaint, provided we do not share its name at this stage. The OIG referral documents specific instances that the complainant asserts are representative of a “systemic pattern of misconduct by Medicare contractors.”
The complaint says that such misconduct “enriches contractors at the expense of providers and the Medicare Trust Fund.” It further notes that offending contractors continue to operate with CMS trust while the Center’s leadership remains focused only on a limited number of fraudulent providers.
Demand for Restitution and Reform
Dr. Mehmet Oz shifted uncomfortably in his chair, a look that signaled something between frustration and distress clouding his famous face. The new CMS Administrator removed his reading glasses, laid the Medicare consultant’s letter on his desk, thanked his aide for handing it to him, and asked her to close the door behind her as she left. Who he may have called next is anyone’s guess, but he did have a staffer tell the letter-writer, “We called the MAC; they said they didn’t do it.”
The OIG referral specifically requests that:
- CMS take immediate investigative action
- All affected providers receive restitution with interest, and
- CMS subject the entire contractor model to a thorough audit, similar in rigor to prior OIG reviews that uncovered widespread errors in contractor processes, some going back decades.
The complaint emphasizes that, while effective detection and elimination of actual fraud is essential, it must not come at the expense of compliant providers.
Strength in Numbers: Protect Your Agency
As we did in our first report of this series, we are opening our doors, well, our contact information anyway, to all Home Health and Hospice providers in the Medicare program. CMS may be able to ignore evidence from one or two providers, but a larger volume of consistent reports is harder to ignore. Write to us at editor@therowanreport.com, or Tim@RowanResources.com. If putting your story in writing makes you nervous, call me at 719-499-8902. You have seen how I protect the identity of the two providers outlined in this story. I will do the same for you.
We also have ways to help you find assistance to write your own OIG complaint. Once we get 100 or more complaints submitted, we will have status to demand Congressional hearings. You can be part of the solution.
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Tim Rowan is a 33-year home care technology consultant who co-founded and served as Editor and principal writer of this publication for 25 years. He continues to occasionally contribute news and analysis articles under The Rowan Report’s new ownership. He also continues to work part-time as a Home Care recruiting and retention consultant. More information: RowanResources.com
Tim@RowanResources.com
©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com
