Fraud in Hospice

By Elizabeth E. Hogue, Esq.

Fraud in Hospice Today

Between a Rock and a Hard Place

The crackdown on fraud in the hospice industry has begun and will undoubtedly continue for some time. Many believe that this crackdown is way overdue. Efforts to eliminate fraud are likely to negatively impact the hospice industry; causing significant damage or even destruction of its credibility. The result may be that patients are no longer willing to receive hospice care. These negative effects could spill over to other types of services provided in patients’ homes, such as home health services.

Examples of Fraud in Hospice

Placed in Hospice Care Without Knowledge

A former Louisiana resident was sentenced to 6 years in prison for conspiracy to commit health care fraud and 3 counts of health care fraud. Evidence presented at trial demonstrated that 24 patients were admitted to the hospice who had not been diagnosed with a terminal condition. Many of the patients and their families never knew they had been placed in hospice care. A patient testified at trial that Medicare refused to cover a procedure he needed because, without his knowledge, he was a patient of a hospice.

Fake Charts

A defendant in California told prospective patients that they did not have to be dying to receive hospice services. After collecting identifying information from prospective patients who were not terminally ill, the hospice billed the Medicare Program for services provided to the patients. When the Medicare Program requested additional information to support claims submitted, the owners directed employees to create fake patient charts that were submitted to Medicare.

Make the Patient go "Bye-Bye"

A Texas hospice owner sent employees a text that said, “You need to make this patient go bye-bye.” Giving the owner every benefit of the doubt and allowing for misunderstandings that may arise from text messages, it seems impossible to justify this communication.

Another owner of a hospice in Texas sent a text message to a hospice nurse telling her to take over for nurses who weren’t doing their jobs. The owner went on to say: “I told this chick that if she would just give her 1 ml of Ativan and turn her she would die,” and “[expletive] woman is still alive…I need boots on the ground.” After the nurse took over the care of the patient, as instructed, the owner then texted “nice work.”

Make this patient go bye-bye

Hospice Without a Terminal Illness

A physician was the medical director of several hospice companies. He fraudulently certified that patients of these hospices had terminal illnesses when they did not. In 2015, the physician was listed as the attending physician for more hospice claims paid by the Medicare Program than any other doctor in the country.

Kickbacks

The medical director of another hospice with dozens of locations certified unqualified patients for hospice care. In addition to payment for his services as medical director, he received other perks, including luxury trips and bottle service at exclusive nightclubs.

Final Thoughts

The need for enforcement action is clear, but what effect will these efforts have on the general public and the public’s willingness to use hospice and other services? The backlash from learning that providers who are supposed to care for patients and their families in their dying moments actually engaged in fraudulent conduct may be horrendous – even catastrophic – in terms of utilization of hospice services. Even compliant hospices and other types of providers may feel severe adverse effects. So sad for everyone.

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Elizabeth E. Hogue, Esq The Rowan Report
Elizabeth E. Hogue, Esq The Rowan Report

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©2026 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. 

Solutions Provider Expands Home Health Footprint

by Kristin Rowan, Editor

Solutions Provider Expands Home Health Footprint

An Interview with Mike Scarbrough

LivTech may not be a name with which you are familiar. I wasn’t. But, you are likely familiar with the brands this private equity firm has acquired. Worldview reduces document processing time for home health and hospice agencies. Qualis manages DME workflows for hospice agencies. Ally handles invoicing, payments, and record-keeping for 1099 caregivers while keeping registries aligned with regulations. And now, LivTech has acquired Alora, the cloud-based full workflow solution for home health, hospice, and home care.

Why Alora?

CEO Mike Scarbrough, who saw a lot of industry growth when working in the ambulatory space, got excited about the post acute market. LivTech has now been operating in the care at home space for a while with their acquisitions of Worldview and Thornberry. With that foothold, the company looked to have a significant presence in home health, tie all their care at home products together, and provide their customers with a migration path forward, Scarbrough said.

Alora is built for home health, hospice, and home care

“In home health and home care, a lot of our customers are or are contemplating doing both. We hear a lot that choosing different solutions for home health, home care, and hospice is difficult. We have a suite of products that will do all three after the integration, which will take months, not years,” Scarbrough said. “The Alora platform was very purpose-built, has a rich feature set, has consistently high NPS scores, and has very low churn. More importantly, Alora has a great personality and culture fit with LivTech.”

What to Expect

I asked Scarbrough what the future holds for LivTech as the integration finalizes and what LivTech and Alora customers should expect. He explained that LivTech offers solutions, not software. Their software platforms form the foundation, but their customers also get support, road maps, and best practices.

“The people we work with are care oriented, as they should be. We want to take the work they do and make it easier so they can focus on what matters, patient care.”

Mike Scarbrough

CEO, LivTech

The Path

To make the job easier for the caregivers, LivTech takes what they know as technologists and applies that to what they understand about home health. This involves ambient transcription, chart summaries, drift notification, audits and surveys, and information flow. They also use their understanding of home health to know where NOT to insert their technology: between the caregiver and the care. The solutions augment care and make suggestions, but never make decisions about care.

AI and the Future of LivTech

The question asked of every solution provider, technologist, and consultant recently is “What about AI?” Scarbrough noted the dramatic changes in the AI tool chain in the last six months, changing the pace of software development. He said these changes are going to make some things obsolete and push developers to focus less on how the tech works and more on the problem their trying to solve. We will rely more on expert problem solvers than on tech experts. Scarbrough predicts exponential growth in what software can do, real solutions that weren’t possible before.

When I asked how he felt about the future of LivTech after the acquisition of Alora, he said:

“I’m super excited and motivated to grow the business. The people we sell to and the people who work for us continue to amaze with their commitment and passion for the work they do.”

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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

 

Fight Loss of Rural Veteran Care: An Interview with Angelo Spinola

by Kristin Rowan, Editor

Fight Against the Loss of Rural Veteran Care

Deep Cuts Impact All

Last November, the U.S. Department of Veterans Affairs (VA) announced the 2026 VA Fee schedule, which became effective January 1st. There were significant changes to the fee schedule compared with previous years. By far the most concerning, though, was the “rate restructuring” for Home Health Aide and Homemaker codes in Texas and New Mexico.

Rate Restructure

Prior to 2026, Texas VA had a tiered fee structure. The tiered structure applied different rates for geographical areas based on _____. The restructure for 2026 applied a single statewide rate. This gave a slight increase in rate for some urban and suburban areas. However, the change created a drastic drop in rates for rural areas. For most Texas rural areas, it is a 43% reduction for Home Health Aides. The restructing results in a 19% decrease in New Mexico.

Tiered Rates

2025 VAFS rates were as high as $67 per hour in some rural areas. The hourly rate covered the time spent in the home, greatly increased travel time compared to urban visits, and differential incentives to entice caregivers to take these shifts that are often short and spread apart. The new statewide rate is $38 per hour. For the highest paying rural areas, this is a 43% rate cut. 

Hours per Veteran

In addition to the rate cut, the number of hours per veteran has also dropped to an average 3.4 hours per shift. Some veterans are seeing their monthly hours cut by more than 30%. 

Advocating for Change

State and national associations and advocacy groups reached out to the VA. Six senators and congresspeople reached out Doug Collins, secretary of the VA, to express their concerns. The VA has largely not responded to inquiries about the validity of the rate reduction and has not provided the analysis used to decide the new rate.

Notice and Comment Period

Most rate changes like this require advanced notice for agencies to adjust as well as a comment period when interested and impacted parties can contact lawmakers to provide feedback and ask questions. The announcement about these rate changes came in December and went into effect in January. The VA provided almost no notice and did not entertain comments or questions.

Fight Against VA Rate Cuts Texas New Mexico

Collins Responds

“[The rate reductions] reflect our assessment that prior rates for these areas significantly exceeded prevailing market rates. Aligning these rates with market conditions is not expected to affect veteran care.”

Doug Collins

Secretary, U.S. Department of Veterans Affairs

Defying His Objective

When Collins accepted the role of Secretary of the VA, he thanked President Trump for the assignment and asked him, “What would you like me to do?” The President answered, “Take care of my Veterans.” In a statement to the press, Collins outlined how he would accomplish that mission. Second on his list is to “put Veterans as the center of everything VA does, focusing relentlessly on customer service and convenience.” 

Fail

Creating care deserts in rural areas and forcing veterans to travel up to an hour to get care is not convenient. Reducing home care hours and raising the probability of veterans having to move to care facilities is not service. Secretary Collins is failing in his objective and failing his directive from the President. More importantly, he is failing our veterans.

Coalition with Polsinelli

The Rowan Report spoke with Angelo Spinola and Heather Looby of Polsinelli. Polsinelli has been actively working on getting the rate changes reversed. Spinola, an employment litigator with a special interest in home care, explained the situation in more detail. According to Spinola there has been little information from the VA and what communication exists has been inconsistent. Many of the letters sent to the VA get no response at all. Spinola says there are legal remedies available, but they are challenging and expensive. In a letter to the VA, Polsinelli outlined the risks and consequences of these actions and gave the VA 30 days to respond.

Join the Fight

Next week, we will bring you real stories of agencies and veterans impacted by the changes in Texas and New Mexico. Their stories are powerful and moving. Even still, you may think this isn’t your fight because

  • A small enough percentage of your business is impacted
  • You have agencies in other states making up the difference
  • You don’t operate in Texas or New Mexico

Angelo cautions:

If they can do it in TX and NM, they can do it anywhere

“They” might be the VA changing rates that are unsubstantiated and contrary to the Administrative Procedure Act.

“They” might be CMS following suit and arbitrarily changing rates without analysis, notice, or comment.

“[Whether you are currently impacted by these changes or not,] the industry needs to get together to address this and join the fight before it’s too late; before it becomes the norm. “

Angelo Spinola

Home Health, Home Care & Hospice Chair, Polsinelli

How You Can Help

Write to your congressperson and senator and urge them to push Collins and the VA to reverse this change

Write to Collins and the VA directly with impact statements and concerns

Join the coalition with Polsinelli – PolsinelliHomeCare@polsinelli.com

Final Thoughts

We have interviews scheduled with providers and veterans to bring you real stories of how this is impacting our industry. We will also continue our discussions with Polsinelli to get additional information and keep you updated on the progress of the 30-day deadline and additional action the coalition will take. 

Honor our Veterans

It was just a few days ago that our nation celebrated Memorial Day in honor of the ultimate sacrifice made by so many. There are too many service men and women who never came home. The ones who did risked everything for you, for me, for this country, and for the ideals that make the United States what it is. They deserve to come home after that service and age with dignity and grace in their homes for as long as they can. We owe them at least that. We all have our own stories and paths that led us to care at home, but at the core of each of those stories is care. Our veterans need that care now. Reach out, write, advocate, join. Whatever you are able to do, now is the time for action.

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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

 

Medicare Moratoria

by Kristin Rowan, Editor

Medicare Moratoria

CMS Halts All New Home Health & Hospice Agencies

As part of it’s ongoing efforts to curb Medicare waste, fraud, and abuse, the Centers for Medicare and Medicaid Services (CMS) is taking a bold step. On Wednesday, May 13, 2026, CMS announced a 6-month moratoria on home health and hospice agency enrollment. Aimed at protecting Medicare beneficiaries and taxpayer dollars, the moratoria will temporarily stop new enrollment of providers in home health and hospice, which CMS calls “high-risk” categories and key sources of fraudulent activity. CMS states this effort builds on additional fraud prevention initiatives, including enhanced screening, site visits, and expanded oversight activities across the hospice and home health sectors

Medicare Moratoria

More Investigations

Together with Vice President JD Vance’s Anti-Fraud Task Force, CMS will increase its targeted investigations of hospice and home health agencies that are suspected of fraud. CMS promises to use advanced data analytics and to accelerate the removal of fraudulent hospice and home health agencies. 

Skirting Authority

CMS investigations revealed that some agencies intent on committing fraud are closing their businesses and reopening under different names in different states to perpetrate additional fraud. The moratoria will prevent these agencies from skirting authority in this manner. Additionally, the moratoria applies to some changes in ownership, which is a common technique used to hide these “bad actors.”

What it Means for You

The moratoria do not apply to existing providers with current enrollments. You can continue to deliver services to Medicare beneficiaries as long as your enrollment is current and in good standing. 

Statement from CMS

“We’ve seen systemic and deeply troubling fraud in the hospice and home health space, with bad actors exploiting some of our most vulnerable Medicare patients and stealing money from the American taxpayer. Today we’re shutting the door on fraud—preventing new bad actors from entering Medicare while we aggressively identify, investigate, and remove those already exploiting them. This is about protecting patients, restoring integrity, and safeguarding taxpayer dollars.”

Dr. Mehmet Oz

Administrator, Centers for Medicare and Medicaid Services

More Information

The administration’s anti- fraud, waste, and abuse efforts are ongoing.

Read the CMS Press Release

Full text of the Home Health Moratorium

 Full text of the Hospice Moratorium

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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

 

Private Payors Against Fraud

by Elizabeth E. Hogue, Esq.

Private Payors Against Fraud

Join Enforcement Efforts

There seems to be a persistent myth among providers of private duty/homecare services that the federal anti-kickback statute applies to Medicare-certified providers only. On the contrary, the anti-kickback statute applies to providers who receive funds from any state or federal healthcare program; including the Medicaid Program, VA, TRICARE, etc. Private duty providers: This means many of you! Lately it has become clear that private payors have joined fraud enforcement efforts.

Guilty

In a recent case, a provider in Detroit pled guilty to conspiring to commit health care fraud. The conspiracy resulted in losses totaling $1.9 million to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. The investigation was conducted by the FBI and the Office of Inspector General of the U.S. Department of Health and Human Services, the primary enforcer of fraud and abuse prohibitions.

Ghost Services

At the plea hearing, the provider admitted to creating and operating a scheme to submit false and fraudulent claims that were medically unnecessary or not actually provided. In some instances, services billed were not ordered by physicians. The scheme continued for over five years. The provider used the proceeds of fraud for his personal use and to benefit others.

Consequences

After a presentence report is prepared, the provider faces a possible maximum sentence of ten years in prison, a fine of up to $250,000 and up to three years of supervised release following any term of imprisonment.

Private Payers Against Fraud

Federal and Private Prosecution

It is important to note that the provider was criminally prosecuted not only for fraud with regard to claims submitted to Medicare and Medicaid Programs, but also fraud committed against a private payor, Blue Cross Blue Shield.

Your Payor Could Report You

It now appears that providers who receive payments from third party payors must be concerned about fraud enforcement. Consequently, providers of private duty/home care services must develop, implement, and update Compliance Programs.

Compliance Programs

Compliance Programs are specific types of documents that routinely address issues that providers do not usually cover in internal policies and procedures. In addition, providers may not gain benefits related to fraud enforcement if there is no formal document called a Compliance Program.

More than Accreditation

Some providers think that accreditation means they are in compliance. On the contrary, providers may be accredited but fail to meet applicable compliance standards for fraud and abuse. Compliance Programs appropriately address potential fraud and abuse issues. They also include mechanisms for helping to ensure compliance, such as processes for identification and correction of potential problems that are not addressed during the certification process.

It Could Save You

Providers also need to know that developing, implementing, and updating Compliance Programs may make a considerable difference during fraud enforcement actions. If providers have Compliance Programs in place that are current and fully implemented, enforcers may be less aggressive in pursuing potential violations.

Corporate Integrity Agreement

When enforcers discover problems with fraud and abuse in organizations, providers are usually asked to develop and implement a Corporate Integrity Agreement (CIA). This type of agreement is likely to include processes for stringent monitoring on a continuous basis. These monitoring activities can be extremely burdensome to providers in terms of both time and money. Providers with valid Compliance Programs are not necessarily asked to develop and implement CIA’s.

Final Thoughts

Now is the time for all providers, including private duty/home care companies, to recognize and act upon the need to establish and maintain Compliance Programs. “Working on it” is no longer good enough.

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Elizabeth E. Hogue, Esq The Rowan Report
Elizabeth E. Hogue, Esq The Rowan Report

Elizabeth Hogue is an attorney in private practice with extensive experience in health care. She represents clients across the U.S., including professional associations, managed care providers, hospitals, long-term care facilities, home health agencies, durable medical equipment companies, and hospices.

©2026 Elizabeth E. Hogue, Esq. All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. 

Medicaid Reform

by Kristin Rowan, Editor

Medicaid Reform

New Efforts to Stop Fraud Before it Happens

As auditors continue to investigate fraudulent activity, new initiatives through Medicare reform aim to stop fraud before it happens. The new initiative, the Combating Deceptive Practices in Assistance Programs Act adds oversight to the Medicaid program.

Preserve Medicaid through Reform

Chairman of the Joint Economic Committee and Chairman of the House Ways and Means Oversight Subcommittee, Rep. David Schweikert, announced the legislation that would tighten eligibility requirements for home health services through Medicaid. The bill requires Medicaid recipients to prove they are unable to perform three or more ADL’s without assistance.

If we seriously want to preserve Medicaid, and provide for the people most in need, we must crack down on fraud. Reaching people that need these services the most should be the top priority of these programs, not growing one of the largest jobs corps in the state. With the U.S. adding almost $87,000 per second to our national debt, making commonsense reforms can save tens of billions of dollars while protecting the truly vulnerable.”

Rep. David Schweikert

Chairman, Joint Economic Committee and House Ways and Means Oversight Subcommittee

Medicaid Waiver Programs

According to the statement from the Joint Economic Committee, the federal waiver programs that allow states to provide at home care for Medicaid beneficiaries are lacking guardrails and oversight. The state policies are “egregious” and lead to waste, fraud, and abuse.

For example, the New York State Medicaid program includes the Consumer Directed Personal Assistance Program (CDPAP) which allows beneficiaries to choose their caregiver. This broad eligibility program allows enrollees to choose friends or family members with no caregiving experience. New York’s Medicaid spending jumped from $2.5 billion in 2019 to more than $9 billion in 2023 with estimates of $12 billion in 2025.

More Information

Read H. R. 7713

Read the accompanying brief from the Joint Economic Committee: From Care to Cash: Correting Misaligned Incentives in Home Health

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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

 

Idaho Approves $22M Cut

by Kristin Rowan, Editor

Idaho Approves $22M Cut

Provider Reimbursement Rates Slashed

Idaho Governor Brad Little approved House Bill 863 in late March after the bill passed the House and Senate. Little directed the state to balance the budget and sent a recommended list of cuts. Among the recommendations was provider reimbursement rates for residential habilitation services, where lawmakers chose to cut nearly $22 million.

Cut Reverses Raises

The State approved pay raises for providers in 2022. This bill reduces those raises for next fiscal year. Combined with previous Medicaid rate cuts, this amounts to a 10% rate reduction for habilitation providers. Lawmakers say this rate is still 33% higher than four years ago.

An Impossible Decision

Lawmakers say balancing the budget required impossible decisions. For Medicaid, the decision was between cutting the Medicaid expansion, and cutting services for people with disabilities. As evidence of the difficulty of the decision, the proposal was delayed twice and was replaced once with a proposal to repeal Medicaid expansion.

Tighten Your Belt

Co-sponsor of the bill, Senator Julie VanOrden, said to follow the money. “The money [goes] from the state to the provider to the caregiver. Somewhere along there, maybe somebody needs to tighten the belt somewhere…. That might mean, as a provider, I don’t take as much money, but I still pay the people that are doing the work the amount that they need.”

HHAeXchange Responds

The Rowan Report reached out to HHAeXchange president Stephen Vaccaro for a comment.

“Idaho’s recent Medicaid disability-services cuts and Colorado’s proposed reductions point to a broader pattern. When states look for Medicaid savings, home and community-based services (HCBS) are often among the first areas affected. But for people who rely on care at home, these supports are essential. They make it possible for individuals to remain safely in the community, rather than shifting into disruptive, higher-acuity settings.

While cutting HCBS may lower spending in one line item, states can end up shifting costs to more intensive settings, like emergency departments and long-term care facilities. To build a more sustainable Medicaid program, states must look beyond immediate savings and consider the longer-term impact of weakening access to services that help prevent more costly outcomes.

States must continue to address fraud, waste, and abuse to protect the long-term health of Medicaid. However, jeopardizing the critical services that people rely on is not the answer. Oversight and accountability should go hand in hand with preserving access to care at home.”

Stephen Vaccaro

President, HHAeXchange

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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

 

California Hospice Fraud

by Kristin Rowan, Editor

California Hospice Fraud

Update 04-16-2026

Reports continue of additional arrests and revoked licenses in the California Hospice Fraud investigations. The anti-fraud task force suspensions rose to 447 hospices and 23 home health agencies this week. The total estimated fraud is more than $600 million. A White House official said, “[the task force] is reviewing and pursuing every possible lead. These suspension numbers, and the dollar values saved, are only going to increase.” Dr. Oz has promised to investigate “every single hospice in California.”

Multiple Arrests and Charges

Hospice fraud has been under investigation with much scrutiny by CMS. National efforts against waste, fraud, and abuse have focused on states with high probability of defrauding the Medicare Trust Fund. On April 9, 2026, California Attorney General Rob Bonta announced charges filed against 21 suspects accused of defrauding the government of $267 million. Five people were arrested and two handguns and more than $750,000 in cash were seized.

Intent to Defraud

After a credible report of fraud, an investigation ensued. The investigation uncovered this scheme. Individuals bought personal identifying information (PII) from people not living in California. They bought the PII through the dark web. They then enrolled these “people” in Medi-Cal, the California Medicaid program. Straw owners purchased 14 hospice companies and started billing Medi-Cal for hospice services for the stolen identities without providing those services.

Location Search

As part of a separate hospice fraud investigation, agencies conducted compliance reviews at a single location in Van Nuys. The address is home to more than 125 individual businesses. Of those, only 19 are licensed by the state and eligible to bill Medi-Cal. 60 percent of the remaining 109 businesses applied for hospice licenses and were denied by the state based on the moratorium on new hospices in place in California since 2021.

The 71 Million Dollar Doctor

Dr. Rajiv Bhuva has connections to Medicare claims from 126 different hospices in California, 115 of which are in LA County. The claims are for almost 2,800 patients. The average doctor cares for 140 patients annually. Dr. Oz confirmed that CMS has revoked Dr. Bhuva’s ability to bill Medicare. Dr. Bhuva has not yet been charged with a crime. A similar case in 2024 resulted in the conviction of Dr. Domingo Barrientos on the charge of conspiracy to commit healthcare fraud. Dr. Barrientos is in federal prison.

Task Force Suspends Providers

A federal anti-fraud task force working in California is investigating both hospice and home health providers. The focus is currently on Los Angeles and LA County, where high numbers of new agencies raised suspicion. As efforts have ramped up, the task force reported suspending 70 providers last week and a staggering 221 total providers suspended so far. The task force anticipates dramatically higher numbers before they’re done. The operation has identified multiple defendants and hundreds of millions in fraudulent claims.

# # #

Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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

 

Accountability and Sustainability in Medicare Advantage

by Kristin Rowan, Editor

Accountability and Sustainability

CMS Finalizes 2027 Medicare Advantage and Part D Changes

As part of its ongoing efforts to reduce unneccessary payments, CMS issued the 2027 Medicare Advantage (MA) and Part D announcement to “improve payment accuracy” in both programs. The changes aim to make MA sustainable, allow beneficiaries to choose the best health coverage for their needs with maximum value, and make Medicare coverage more affordable.

“CMS’ vision for Medicare Advantage and Part D is clear: a great choice for seniors and a smart deal for taxpayers. The Rate Announcement improves payment accuracy and strengthens competition based on quality—not on coding practices—helping put the program on a more sustainable path for the long term.”

Chris Klomp

Director of Medicare and Chief Counselor, U.S. Department of Health and Human Services

Rate Changes for MA Risk Adjustment Model

The Rate Announcement policy changes address coding differences between MA and traditional Medicare. MA is moving toward a risk adjustment system guided by:

  • Reducing administrative burdens for plans and providers
  • Equalizing competition for all MA plans regardless of size or resources
  • Achieving payments that accurately reflect health risk
  • Facilitating the efficient use of healthcare resources, enhanced program integrity, and greater accountability
CMS will continue using the 2024 risk adjustment model in pursuit of these changes. However, CMS will exclude diagnosis information from unlinked chart review records from risk score calculation. There is an exception from the exclusion for beneficiaries who switch MA providers. The exclusion does not apply to PACE organizations, which will continue to use a blend of the 2017 and 2024 risk adjustment models. CMS expects this change to lower payments to MA plans by more than $7 billion in 2027.

Part D Risk Adjustment Model

Deductible

Part D beneficiaries cover 100% of the costs of their prescriptions, except insulin and recommended vaccines, until the deductible is met.  The 2027 deductible will increase from $615 to $700.

Out-of-pocket maximum

After sunsetting the coverage gap phase in 2025, beneficiaries no long have an initial coverage limit. The initial coverage phase lasts until the annual out-of-pocket (OOP) maximum is reached. CMS is also using the API indexing method to establish the annual OOP threshold. The annual OOP will increase from $2,100 to $2,400 in 2027.

Calculation method

CMS can use one of two methods to update the annual deductible amount. The annual percentage increase (API) measures the average plan expenses per beneficiary. The Consumer Price Index (CPI) measures the annual percentage increase of all items across the U.S.

The 2026 API is 9.37%. The 2026 CPI is 2.31% CMS chose to use the API indexing method to set the 2027 deductible.

Accountability and Sustainability API and CPI 2027 Medicare Advantage Part D

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Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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

 

Worthy is Worthy of Consideration

by Kristin Rowan, Editor

Worthy is Worthy

Markovich Calls for Healthcare Overhaul

Worthy is an initiative aimed at nonpartisal healthcare policy reform. Introduced by Ascendiun CEO Paul Markovitch. Worthy calls upon industry players to back major reform in the healthcare system that addresses long-standing problems. According to Markovitch, a 30-year veteran in healthcare, the industry is dysfunctional and in need of a major overhaul. 

“The healthcare system is bankrupting and failing us. It requires systemic reform. Those reforms are unlikely to come from the industry itself. Therefore, we need the federal government to step up and make those reforms happen. The status quo is unacceptable. We need bold, systemic reform urgently, so that is what Worthy is.”

Paul Markovich

CEO, Ascendiun

Worthy Outline

Worthy comes from the idea that our healthcare system ought to be “worthy of our family and friends,” Markovitch said. The overhaul program is built on strategic pillars:

  • Providing every consumer and patient with a comprehensive, real-time digital health record
  • Breaking the “do more, get paid more” fee-for-service model and instead start paying for health outcomes.
  • Make prescription drugs accessible and affordable by eliminating kickbacks in the form of rebates, fees and spread pricing.
  • Put the entire healthcare system on a budget

More than Strategy

Beyond the written initiative, Worthy provides an interactive framework for patients. The website houses podcasts, issue analysis, and videos complemented by social media posts, media commentary, and in-person forums to help consumers and patients understand the changes that need to happen and how to get there. 

Additionally, it seems as though the Worthy plan is not merely speculation. The first phase of the plan focuses on prescription drug reform. The plan is already active inside Blue Shield of California. The insurer changed its pharmacy model, moving away from the pharmacy benefit management (PBM) structure. Instead, Blue Shield of California partners with Amazon Pharmacy, Mark Cuban Cost Plus Drug Company, and Prime Therapeutics, among others. That change became the foundation for the Worthy initiative.

Plan in practice

Blue Shield of California rolled out a Digital Health Record (DHR) program, also now part of the Worthy Initiative, that improves care coordination and transparency. The DHR program in California includes sharing all patient data across providers and with the patient, giving patients a complete and real-time health record. According to Markovitch, interoperability is a meaningless term that allows providers to congratulate themselves for sharing slightly more data than before. His goal is to have a national standard for comprehensive digital health records that eliminates the need for any provider or patient to request records.

Working Together

Worthy presumes that the strategic pillars work together. Total reform doesn’t happen without each piece. Markovitch advocates for the responsible use of artificial intelligence to automate what can be automated. This includes, according to Markovitch, prior authorization, billing, provider directory updates, claims settlements, and routine patient questions.

Shared decision-making

The clinical model that the plan implies is one of shared decision-making. It involves both patient and physician having complete health records together with AI and other technology to gather all available information about a health condition. From there, the patient, loved ones, and all treating physicians work together to form a care plan. Markovitch calls for stronger legislation to move toward this kind of comprehensive care plan.

Worthy shared decision-making

Worthy Vision

Patients over Profits

“Worthy will be advocating for passing a series of laws and enacting regulations that will force all the players to put patients over profits, that is, to do the right thing on behalf of each patient, every time, in order to have a health care business and to earn an income.”

– Paul Markovitch, CEO Ascendiun

Final Thoughts

We don’t know if the Worthy Initiative will gain any ground at the federal level. Likewise, we don’t know if Worthy will make substantive changes to the broken healthcare system. What we do know is that Worthy is, at a minimum, worthy of consideration as a means to overhaul a system that hasn’t truly been effective for a long time. If you agree, here are some links to get more information:

Worthy Podcast

Healthcare Overview

Pharmacy Reform

Blue California Pharmacy Care Reimagined

This is Worthy

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Kristin Rowan Editor The Rowan Report
Kristin Rowan Editor The Rowan Report

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites.  Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.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