The Compliance Monitor (6/12/26)

The Compliance Monitor (6/12/26)

Your source for federal updates 

June 2026 Compliance Activity 

Compliance Item & Date Additional info & Links 
The FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements  

Comments due on June 1, 2026 		FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements  

Read the CHAP summary of the proposed rule.  
Medicare Shared Savings Program: Application Deadlines for January 1, 2027, Start Date  

Accountable Care Organizations (ACOs): See the Medicare Shared Savings Program Application Types & Timeline webpage to learn about key dates for a January 1, 2027, start date. CMS will accept applications starting June 9 through the ACO Management System.   

Apply no later than June 23 at noon ET. 		 

Top Items 

The House Ways & Means Committee approved Two Fraud Bills 

The House Ways and Means Committee advanced several bills to curb waste, fraud, abuse, and errors in the federal budget, while also reauthorizing demonstration authority for the Social Security Disability Insurance (SSDI) program. These measures include the Protecting Seniors and Stopping Fraudsters Act and the DME Scammer Prevention Act of 2026. 

  1. The DME Scammer Prevention Act of 2026 (H.R. 8871) is a bipartisan bill aimed at combating Medicare fraud in the Durable Medical Equipment (DME) sector by mandating electronic billing and reducing the claims submission window from 365 to 90 days. Key provisions include: 
  • Electronic Billing Mandate: Requires suppliers to submit billing claims electronically for specific DME items highly susceptible to fraud, eliminating outdated paper-based and faxed submissions.  
  • 90-Day Submission Window: Requires claims for specified high-risk items to be submitted within 90 days of the physician’s order or date of service. This cuts down on the current 365-day deadline, which previously allowed fraudulent actors to exploit the payment system over time.  
  • GAO Technology Review: Directs the Government Accountability Office (GAO) to submit a comprehensive report to Congress on how Medicare Administrative Contractors (MACs) are using technology to screen and flag suspicious claims.  
  1. The Protecting Seniors and Stopping Fraudsters Act (H.R. 8883) is bipartisan legislation designed to crack down on Medicare fraud within hospice programs and home health agencies. Advanced by the House Ways and Means Committee in May 2026, the bill aims to protect vulnerable seniors and prevent bad actors from exploiting federal healthcare benefits. Key provisions of the bill include: 

Increased Provider Oversight & Scrutiny 

  • More Frequent Inspections: Mandates annual surveys (up from every three years) for newly enrolled hospices and home health agencies (HHAs), those that change ownership, or those that show signs of fraudulent behavior.  
  • Enhanced Screening: Requires fingerprinting for administrators and medical directors at agencies deemed at “extreme risk” of fraud and requires them to provide proof of liability insurance.  

Tougher Penalties for Noncompliance 

  • Data Reporting Penalties: Triples the payment penalty for hospices and HHAs that fail to submit mandatory quality reporting data (raising the penalty from 4% to 15%). This measure targets fraudulent “ghost agencies” that bill Medicare but do not provide legitimate healthcare services.  

Direct Patient Protections 

  • Enrollment Notifications: Requires the Centers for Medicare & Medicaid Services (CMS) to notify seniors when they are enrolled in hospice care so they can confirm the service is legitimate and know how to disenroll if fraud is suspected. 

HHS Announces Federal Elder Justice Action Plan and the EJCC’s “Never EVER” Campaign to Protect Older Americans 

The U.S. Department of Health and Human Services (HHS), through the Elder Justice Coordinating Council (EJCC), announced the Federal Elder Justice Action Plan [PDF], a government-wide strategy to protect older Americans’ rights, strengthen accountability, and make help easier to find. The announcement also launches “Never EVER,” a national campaign that advances the Action Plan’s prevention goals by helping people recognize and avoid government and business imposter scams.  For more information, visit the Elder Justice Coordinating Council website for details about the Council, the Federal Elder Justice Action Plan, and the “Never EVER” campaign. 

CMS Rulemaking 

Federal Rule Takes Aim at Health Care Bureaucracy, Reducing Dispute Fees & Boosting Transparency  

Major reforms were finalized to strengthen the No Surprises Act by making the Federal Independent Dispute Resolution process more efficient and transparent, while also saving money for millions of Americans. The final rule improves the process used to resolve out-of-network payment disputes between providers and payers—cutting administrative costs and improving how disputes are handled. 

More Information: 

Home Health Payment Update Rule Posts in OMB Queue  

The CY 2027 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Payment Update (CMS-1844) proposed rule posed in the Office of Management and Budget’s review queue on 5/11/2026.  CHAP will develop a summary of the prosed rule when it officially posts in the Federal Register.  

Fraud and Abuse Update  

Emerging Hospice Fraud Targeting Medicare Recipients 

The Federal Bureau of Investigation (FBI) is issuing this Public Service Announcement to warn the public of an emerging hospice fraud scheme that targets vulnerable Medicare recipients who are not in need of hospice services. 

Hospice/Palliative Care Provider Updates 

Hospices: Download Your FY 2025 PEPPER 

CMS released the FY 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for hospices. PEPPER helps you review your billing data to make sure claims are accurate. Use it to: 

  • Spot billing patterns that may need improvement 
  • Identify areas that may need audits or closer monitoring 
  • Find diagnosis-related groups that may be under-coded or over-coded 
  • Track areas where patient stays are getting longer 

How to Get Your PEPPER 

Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can download their organization’s report from the PEPPER Portal. 

More Information: 

  • Register for a webinar on June 24 at 1 pm ET 

Training & Resources for Hospices 

PEPPER for Hospices is available via the PEPPER Portal at https://pepper-file.cbrpepper.org. 

Demonstration PEPPER: 

  • Demonstration PEPPER version FY 2025 (XLSX). 

GAO Report: Medicare Hospice: Action Needed to Pay More Efficiently for Routine Home Care (GAO-26-107585) 

The routine home care that makes up the bulk of Medicare hospice care for its beneficiaries is primarily delivered through visits made by nurses, aides and social workers. GAO found that in 2024 for selected beneficiaries and hospices, low-visit hospices—the 20 percent of hospices that delivered the fewest visits per week per beneficiary—averaged about half as many visits per week as high-visit hospices—the 20 percent that delivered the most visits per week. Low-visit hospices delivered a total of 2.5 visits per week on average, compared to a total of 5.5 visits per week on average for high-visit hospices. 

The GAO recommends that Congress consider directing the Secretary of the Department of Health and Human Services (HHS) to revise the hospice payment system for routine home care services to better promote payment efficiency and realize savings for the Medicare program. HHS provided technical comments, which we incorporated as appropriate. 

Home Health Provider Updates 

Expanded HHVBP Model: Final April 2026 Interim Performance Reports (IPRs) are Available in iQIES 

Final April 2026 Interim Performance Reports (IPRs) are Available in iQIES 

The Final April 2026 IPRs for the expanded HHVBP Model have been published in the Internet Quality Improvement and Evaluation System (iQIES). 

The quarterly IPRs provide home health agencies (HHAs) with the cohort assignment, performance year measure data based on measure-specific 12-month and 24-month reporting periods, and the interim Total Performance Score (TPS). Using the IPRs, an HHA can assess and track their performance relative to peers in their respective cohort throughout the expanded Model performance year. 

An HHA receives an April 2026 IPR if the HHA: 

  • Was Medicare certified prior to January 1, 2024, and 
  • Meets the minimum threshold of data for at least one (1) quality measure in the quarterly reporting period for the performance year shown in Exhibit 1. 

Exhibit 1: April 2026 IPR quality measure performance time periods by measure category 

Measure Category Time Period Minimum Data Threshold 
OASIS-based Jan 1, 2025 – Dec 31, 2025 20 home health quality episodes 
Claims-based DTC-PAC: Oct 1, 2023 – Sep 30, 2025 PPH:Oct 1, 2024 – Sep 30, 2025 20 home health stays 
HHCAHPS Survey-based* Oct 1, 2024 – Sep 30, 2025 40 completed surveys 

* Not included in the TPS calculation for HHAs in the smaller-volume cohort. For additional details on cohort assignment in the expanded Model, please review Section 2 in the Expanded HHVBP Model Guide, available on the Expanded HHVBP Model webpage, under “FAQs & Model Guide.” 

DMEPOS Updates 

DME: Complying with Proof of Delivery Requirements 

The Comprehensive Error Rate Testing (CERT) Task Force identified missing or incomplete proof of delivery (POD) documents for DME claims. You’re required to maintain POD documentation for 7 years from the date of service regardless of your delivery method. 

Use the POD Requirements (PDF) work guide to learn what you must include and what’s required for each delivery method. 

More Information: 

DMEPOS Competitive Bidding Phase I Bidder Education: Get Ready for Round 2028 

CMS published detailed fact sheets to help bidders understand DMEPOS Competitive Bidding Program rules and prepare for Round 2028.  

More Information: 

DMEPOS: Bill Correctly for Continuous Positive Airway Pressure Devices 

In a report, the Office of Inspector General found that continuous positive airway pressure (CPAP) devices had the second-highest improper payment amount in the DMEPOS category. Medicare paid claims that didn’t have the required documentation to support the services billed. 

Learn about Medicare coverage requirements for CPAP devices and the documentation you need: 

All Providers Updates  

The Centers for Medicare and Medicaid Services (CMS), Office of Health Technology and Products (OHTP), has been established 

This new organizational component will provide enterprise leadership and oversight for CMS healthcare technology modernization, digital products, and transformation of platforms and services supporting Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and other CMS-administered programs, in close coordination with the CMS Chief Information Officer (CIO) and subject to CIO-led enterprise information technology (IT) governance, cybersecurity, enterprise architecture, and capital planning and investment control responsibilities, as well as CIO-led digital service delivery, customer experience, and public digital experience responsibilities under applicable law. DATES: This new organizational change was approved by the Secretary of Health and Human Services on June 9, 2026, and became effective that same day. 

Medicare Physician Fee Schedule Database: July Update 

See the instructions to your Medicare Administrative Contractor (MAC) (PDF) to learn about the July quarterly updates to the Medicare Physician Fee Schedule Database, including: 

  • New codes 
  • Procedure status changes 
  • Short descriptor code revisions 
  • Payment policy indicator changes 

Your MAC will give you 30-days notice before they implement these changes. After that, they’ll adjust claims that you bring to their attention. 

For more information, see the Medicare Claims Processing Manual, Chapter 23 (PDF), section 30.1. 

  

ACCESS Model: Learn How to Support Your Patients with Chronic Conditions 

CMS launched a new webpage for primary care providers, health centers, pharmacists, and other referring clinicians explaining how the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model can supplement your care for patients with chronic conditions, including diabetes, high blood pressure, chronic musculoskeletal pain, and depression. 

Starting July 5, eligible Original Medicare beneficiaries can sign up with participating ACCESS health care providers to receive technology-supported disease management services at low or no additional cost, such as lifestyle coaching, remote monitoring, wearables, and medication management. 

No ACCESS enrollment is required for primary care providers or referring clinicians. The model works within your existing workflows: Refer patients using the ACCESS Directory (launching July 2026), receive structured care updates at key clinical moments, and bill the co-management payment — a Medicare payment with no beneficiary cost-sharing — for coordinating care. 

If you have questions, contact ACCESSModelTeam@cms.hhs.gov. 

Educational Opportunities 

2026 CMS & HL7 Virtual FHIR Connectathon 

The Centers for Medicare & Medicaid Services (CMS) is excited to announce the 7th annual CMS & Health Level Seven International (HL7®) Fast Healthcare Interoperability Resources (FHIR®) Connectathon, taking place July 14-16, 2026. This virtual collaborative experience will bring together health care interoperability leaders, implementers, and innovators for three days of hands-on testing, shared learning, and alignment on how emerging CMS policies and FHIR-based solutions are taking shape in real-world systems. 

How to Participate: 

Additional details, including registration, track list, and full agenda will be available soon. 

To learn more about the event and ways to participate, please contact: CMSInteroperability@cms.hhs.gov. 

OIG Workplan 

HHS-OIG’s Work Plan sets forth various projects including audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond. The work planning process is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available. 

Review active action items on the Office of the Inspector General’s Work Plan by provider type.