The Compliance Monitor (6/29/26)
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
All Medicare Facility Types: Get Ready for the PEPPER Relaunch
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is relaunching in the coming months for all Medicare facility types, including hospitals, post-acute care providers, and specialty facilities.
PEPPER is a free tool that helps you review your Medicare billing data so you can identify issues before problems arise and support accurate claims. Use it to:
- Spot billing patterns that may need review or improvement
- Identify areas that may need closer monitoring or internal audits
- Find services that may be under‑coded or over‑coded
- Track trends like longer patient stays
How to Get Your PEPPER
Authorized officials (AOs), access managers (AMs), and staff end users (SEUs) can access the reports through the PEPPER Portal.
How to become an SEU:
- Sign in to the CMS Identity & Access (I&A) System using your existing NPPES or PECOS credentials.
- Request the PEPPER business function for your organization. The Comparative Billing Report business function is also available and can be requested at the same time.
- Your AO or AM must approve your request.
More Information:
- Review the User Guide
- See the I&A Quick Reference Guide and FAQs: Step-by-step instructions for AOs and AMs
- Contact the External User Services Help Desk
CMS Rulemaking
CMS Rule: AO Oversight Final Rule with Comment
Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions was posted on the Federal Register Public Inspection desk on 6/12/2026 and is estimated to post in the Federal Register on June 16, 2026. The Centers for Medicare and Medicaid Services (CMS) will accept comments related to the proposed rule through August 17, 2026, 11:59 pm. Information about submitting comments appears at the beginning of the rule. This final rule is effective June 16, 2027.
Read the CHAP customer impact summary of the final rule.
CMS Full press release and Fact sheet
CMS issued a proposed rule to update payment rates and policies under the Medicare End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2027. This rule also proposes updates to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year (CY) 2027 and proposes to update requirements for the ESRD Quality Incentive Program (QIP).
RFI – Opportunity for Hospice Provider Comments
CMS is interested in feedback on potential models and policy approaches, including improving coordination between ESRD care and hospice services while preserving hospice bundle integrity. CMS is exploring whether refinements to payment policy could improve access to palliative dialysis while maintaining the following: ESRD PPS bundled payment integrity; Hospice per diem integrity; and appropriate safeguards against duplicative payment and program integrity risks.
Commenters should go to “C. Request for Information to Advance Palliative Care for Dialysis Patients, 3. Request for Information” in the document to locate the specific questions comment.
CMS Notice: Notice with Comment Period – Submission of 1135 Waiver Request Automated Process
Waivers under Section 1135 of the Social Security Act (the Act) and certain flexibilities allow the CMS to relax certain requirements, known as the Conditions of Participation (CoPs) or Conditions of Coverage to promote the health and safety of beneficiaries. Under Section 1135 of the Act, the Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods. These waivers ensure that healthcare entities/caregivers who provide such services in good faith can be reimbursed and exempted from sanctions.
In 2021, CMS implemented a streamlined, automated process to standardize the 1135 waiver requests and inquiries submitted based on lessons learned during the COVID-19 PHE. They are enhancing this information collection to better support emergency response by capturing the emergency date, simplifying ongoing status updates for stakeholders, and providing a more comprehensive view of cybersecurity incidents through expanded reporting on patient and operational impacts.
Comments are due July 20, 2026
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
HHS Announces Federal Elder Justice Action Plan and the EJCC’s “Never EVER” Campaign to Protect Older Americans
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.
OIG publishes a new video, a report, and 11 enforcement actions.
Video | This Week at HHS‑OIG: June 12, 2026
A new federal–state partnership in Ohio is strengthening the fight against health care fraud—already leading to charges in a multimillion-dollar scheme involving fraudulent Medicaid claims and the seizure of luxury assets purchased with stolen health care dollars. HHS-OIG also released two reports revealing systemic issues in Medicare Advantage prior authorization, where the nation’s three largest managed care companies denied long-term acute care, inpatient rehab, and skilled nursing facility services at some of the highest rates in the industry. Stay informed and watch the full update.
2026 National Health Care Fraud Takedown
The Department of Health and Human Services Office of Inspector General joined federal law enforcement partners to announce 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. The Takedown includes cases in 56 federal districts and 45 U.S. states and territories, with 50 state Medicaid Fraud Control Units participating. This coordinated effort involved the cutting-edge use of data analytics to target the worst actors; the seizure of over $182 million in cash, luxury vehicles, jewelry, and other assets; and full-spectrum accountability for all criminal actors from doctor’s offices to corporate boardrooms.
As part of the national health care fraud takedown, federal law enforcement in the greater Los Angeles metropolitan area have arrested five defendants, including a Whittier woman who participated in a scheme that submitted nearly $270 million in fraudulent claims to Medi-Cal for expensive prescription drugs, and a San Fernando Valley man who is charged with running hospice care companies that fraudulently billed Medicare $27 million.
The charges announced today are part of a strategically coordinated, nationwide law enforcement action that resulted in charges against 455 defendants. The 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.
Hospice/Palliative Care Provider Updates
OIG Report – Medicare Could Have Saved $255.1 Million Related to Hospice Services for Certain New Hospice Enrollees (A-06-22-09003)
OIG reviewed whether the Centers for Medicare & Medicaid Services made appropriate hospice payments for new enrollees who did not have an emergency room or inpatient claim in the 18 months before starting hospice care. OIG found that documentation for 45 of 100 sampled initial certification periods did not meet Medicare requirements, resulting in unallowable payments. Specifically, OIG identified insufficient clinical support for terminal illness and missing eligibility documentation. It is estimated that Medicare could have saved $255.1 million if Medicare Administrative Contractors had eligibility review procedures for these high‑risk cases.
Read the Full Report
Home Health Provider Updates
CMS has updated and created new resources that are available in the “Downloads” section on the HH QRP Quality Measures webpage:
- OASIS-based Discharge Function measure:
- HH_Discharge_Function_Technical_Report_2026 Update.pdf (PDF)
- DC-Function-Imputation-and-Risk-Adjustment-Appendix-HH (2022).xlsx (XLSX): This document includes imputation coefficients for episodes ending between 1/1/23 – 12/31/2025. This also includes risk adjustment episodes ending between 1/1/23 -12/31/24.
- DC-Function-Imputation-and-Risk-Adjustment-Appendix-HH (2023).xlsx (XLSX):
This document includes imputation coefficients for episodes ending between 1/1/23 – 12/31/2025. This also includes risk adjustment episodes ending between 1/1/25 -12/31/25.
This document includes imputation coefficients for episodes ending between 1/1/26 and later. This also includes risk adjustment episodes ending between 1/1/26 and later.
- Quality Measure Tables:
- Claims-based MSBP-PAC measure:
MSPB_PAC_HHA_Service_Exclusions_Update.xlsx (XLSX)
DMEPOS Updates
Intermittent Urinary Catheters: Medicare Improperly Paid Suppliers
In a report, the Office of Inspector General found that Medicare improperly paid for catheters and kits. To avoid improper payments, review the Urological Supplies provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Refill and documentation requirements
- Resources
DMEPOS Competitive Bidding Program
View Frequently Asked Questions about Round 2028 of the DMEPOS Competitive Bidding Program.
All Providers Updates
FDA Approves First Single-Dose Generic Treatment for Influenza
The U.S. Food and Drug Administration today approved the first generic of Xofluza (baloxavir marboxil) tablets, the first single-dose treatment for acute uncomplicated influenza and prophylaxis in patients 5 years of age and older. It is approved in time for the 2026–2027 flu season.
The Office of the National Coordinator for Health Information Technology (ONC) at the U.S. Department of Health and Human Services today announced new steps to strengthen the Trusted Exchange Framework and Common Agreement™ (TEFCA®), the nationwide network that helps patients and healthcare providers securely share electronic health information.
MedPAC June 2026 Report to Congress
The June 2026 MedPAC report to Congress outlines strategies to reform Medicare payment structures, address complexities in beneficiary enrollment, and manage the impact of Medicare Advantage (MA) on provider finances. Key recommendations focus on transitioning to value-based payments, streamlining administrative burdens, and improving access to complex palliative care. Read the full report at MedPAC.
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.
2026 National Provider Compliance Conference – August 11–12
Tuesday, August 11 from 9 am – 5:30 pm ET and Wednesday, August 12 from 9 am – 1 pm ET
Charlotte, NC
Register for this in-person event by July 23; limited spots are available.
The National Provider Compliance Conference will bring together Medicare Administrative Contractors (MACs) and Center for Program Integrity experts to provide compliance professionals with the information and tools they need to efficiently and effectively submit Medicare Part A, Part B, Home Health and Hospice, and Durable Medical Equipment claims. Learning opportunities include individual presentations, Q&A segments, and panel discussions. Additionally, a dedicated exhibit area will allow for individual engagement between MACs and providers.
Target audience: Medicare Fee-for-Service providers only, including medical review contractors, compliance officers, nurse or billing managers, medical record staff, coders, and provider community associations.
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.