The Compliance Monitor (9/14/26)

Your source for federal updates

September/October 2026 Compliance Activity

Compliance Item & Date	Additional info & Links
CMS DMEPOS Enrollment Moratorium Expired Aug 27, 2026	The six-month nationwide Medicare enrollment moratorium on certain DMEPOS supplier types has expired, and enrollment applications are once again being accepted.  The moratorium was implemented by CMS in February 2026 as part of ongoing efforts to address fraud, waste, and abuse within the DMEPOS supplier community.  Read the CHAP blog for additional information.
Submit Comments on the CY 2027 PFS Proposed Rule Policy for Quality Payment Program The palliative care RFI in the CY 2027 Medicare Physician Fee Schedule Proposed Rule asks for stakeholder input on how Medicare might improve coding, payment, and access for palliative care services outside of hospice. It is not a proposal to create a new benefit yet; it is CMS asking questions to inform possible future policy. Sep 14, 2026	The Centers for Medicare & Medicaid Services (CMS) has issued its Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS) Proposed Rule, which includes proposed policies for the Quality Payment Program (QPP).
PEPPER webinar – Home Health September 24, 2026, 1:00 p.m. ET:  Register today.	PEPPER for Home Health Agencies is available via the PEPPER Portal at https://pepper-file.cbrpepper.org. Current PEPPER User Guide: – Home Health Agencies PEPPER User Guide (PDF, CY 2025 Release, August 2026) – Demonstration PEPPER: Demonstration PEPPER version CY 2025 (XLSX)
FY 2027 Hospice Payment Update final rule effective Oct 1, 2026	Provisions of this rule are effective
CMS Home Health Payment Update Rule (Final) Annual CY issuance Usually posted in late October – early November	Will first appear on the Federal Register Public Inspection Desk https://www.federalregister.gov/pu blic-inspection/current Will move over to the Federal Register within a few days of initial posting https://www.federalregister.gov/do cuments/current
CMS HHQRP non-compliance letters – Providers will receive a letter if they are found not in compliance with quality reporting requirements – Providers may submit a request for reconsideration to CMS if they do not agree with the CMS outcome Non-compliance notifications will be distributed by the Medicare Administrative Contractors (MACs) and will be placed into provider CASPER folders in iQIES Usually distributed in October	Instructions for appeal are included in the notification and on the Home Health Quality Reporting Reconsideration and Exception & Extension webpage
Medicare Care Compare Refresh – Home health quality scores are publicly reported on the Care Compare website and updated on a quarterly basis. October 2026	Medicare Care Compare https://www.medicare.gov/care-compare/ Information about home health public reporting dates https://www.cms.gov/medicare/quality/home-health/home-health-quality-reporting-data-submission-deadlines

CMS Rulemaking/ Federal Register Notices/RFIs

The FY 2027 Hospice Final Rule regulatory provisions that are effective October 1, 2026.

FY 2027 hospice wage index, payment rates, and aggregate cap amount updates for the hospice fiscal year.
- 2.3% hospice payment update for FY 2027; hospices that fail to meet quality reporting requirements receive the update reduced by 4 percentage points, resulting in a -1.7% update.
- FY 2027 hospice cap amount of $36,174.75.
Hospice election statement addendum requirement expanded so hospices must provide the addendum to all Medicare beneficiaries at the time of hospice election.
Conforming discharge regulation changes allowing a physician designee and the physician member of the interdisciplinary group, in addition to the hospice medical director, to discharge a patient from hospice care.
Telehealth flexibility continues for hospice recertification face-to-face encounters. CMS finalized conforming regulation text changes to align hospice rules with the statutory telehealth flexibility for the required face-to-face encounter before the third benefit period and each subsequent benefit period.
- Claims coding changes begin January 1, 2027. A new claims code, G0679, is referenced in implementation guidance for reporting when the face-to-face encounter was conducted via telehealth; it should not be reported for in-person encounters.
New public reporting indicator for HQRP non-compliance: CMS finalized adding an icon on Medicare.gov Care Compare to identify hospice providers that either fail to submit any HQRP data or submit less than 90% of required HQRP data. The icon is intended to increase transparency for beneficiaries and families when comparing hospice providers.
- Timing of the Care Compare icon: The icon will appear no earlier than FY 2028 and will be based on CY 2026 Annual Payment Update submission data. This means the FY 2027 rule establishes the policy, but the public display will occur later.
Program integrity/non-hospice spending analysis, including use of the hospice service and spending variation index (SSVI), is included in the final rule; this portion supports oversight and education rather than creating a direct provider compliance date in the same way as the payment/election provisions.

Sources: CMS FY 2027 Hospice Final Rule Fact Sheet and Federal Register final rule.

Privacy Act of 1974; System of Records – Notice of a modified system of records

In accordance with the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS) is modifying an existing system of records maintained by the Centers for Medicare & Medicaid Services (CMS), titled “Hospice Item Set (HIS) System,” System No. 09-70-0548. The amended System of Records Notice (SORN) reflects changes to now include real time data collection at the time of patient assessments to improve the understanding of patient care needs and care coordination. CMS is also changing the name of the system of records to “Hospice Outcomes and Patient Evaluation (HOPE)” and making other modifications which are explained in the Supplementary Information section. The HOPE system collects standardized hospice patient data to measure and improve care quality, support regulatory and reporting requirements, and enable research and policy functions. DATES: In accordance with 5 U.S.C. 552a(e)(4) and (11), this modified system of records notice is effective upon publication.

The primary reason for this modification is to highlight the inclusion of real time data collection from hospice providers at the time of patient assessments while the beneficiary is receiving hospice services, and not only at the point of admissions and discharges from hospice care.

There is a 30-day comment period for this notice (10/8/2026).

Fraud and Abuse Update

CMS Cracks Down on Massive $3.4 Billion Medical Equipment Supplier Fraud Scheme

The Centers for Medicare & Medicaid Services (CMS) has barred 11 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) companies from receiving future Medicare Advantage (MA) Part C and Part D payments due to over $3.4 billion in suspected fraudulent billing practices during 2025 and 2026.

Key Details of the Enforcement Action:

Fraudulent Practices: The 11 suppliers had submitted no claims prior to 2025, used improper billing practices, billed for medical equipment provided to deceased beneficiaries, and billed for supplies that beneficiaries never requested or received.

Original Medicare to MA Switching: Four of the suppliers had previously been revoked from Original Medicare and transitioned to billing Medicare Advantage plans instead.

Major Intercepted Claims:
- A Florida supplier submitted approximately $18.4 million in catheter claims over two days: $6.1 million for 500 beneficiaries on December 15, 2025, and $12.3 million for 777 beneficiaries the next day. CMS stopped the claims through payment suspension.
- A Texas supplier submitted approximately $5.5 million in orthotics claims for non-operational locations, including claims made after beneficiaries’ deaths and orders unknown to patients.

* **Preclusion List Placement:** Working alongside the HHS Office of Inspector General (HHS-OIG), CMS placed these entities on its Preclusion List to prevent further payments for healthcare items, services, or drugs.

New Video | OIG Office of Evaluation and Inspections: Impacting HHS Programs and the Lives of Americans

Within OIG, the Office of Evaluation and Inspections (OEI) provides oversight at a national scale and focuses on one powerful idea: How do we ensure that every federal dollar delivers maximum value for the American people? For HHS programs, OEI achieves this objective by producing reports that prevent fraud, identify savings, and protect the well-being of the American public. Watch our new video detailing the impact of OEI’s efforts. 

Home Health Care Provider Updates

 PEPPER Updates for Home Health Agencies & Partial Hospitalization Programs Webinar – September 24 

Thursday, September 24 from 1–2 pm ET

Join CMS to review the FY 2025 Program for Evaluating Payment Patterns Electronic Report (PEPPER) for:

Home health agencies released in August 2026

Partial hospitalization programs released in September 2026

The session will provide participants with guidance on navigating the recent changes, including a review of the reports.

Prior to the webinar, send your questions to CMS_CBRPEPPER@cms.hhs.gov. Visit the Training & Resources webpage for more information.

DMEPOS Updates

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.

See the Continuous Positive Airway Pressure Devices & Accessories provider compliance tip to learn about Medicare coverage requirements for CPAP devices and the documentation you need.

Expanded HCPCs Codes – Oct 28, 2026

The Centers for Medicare & Medicaid Services (CMS) is expanding the prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items by adding eight HCPCS codes to the Required Prior Authorization List.

For dates of service on or after October 28, 2026, claims for these items must receive a provisional affirmation decision before payment can be made; claims submitted without the required prior authorization may be denied.

The July 30 Federal Register notice identifies the affected HCPCS codes: K0005, E0194, L1833, L0456, L0457, L0486, L3761, and L3916.

CMS states that prior authorization helps ensure these items meet Medicare coverage, coding, and payment rules before services are furnished and supports its broader efforts to reduce improper payments, fraud, waste, and abuse.

DMEPOS Benefit Category Determinations

CMS updated the Medicare Benefit Policy Manual, Chapter 15 (PDF), Section 110.8 with DMEPOS benefit category determinations.

See the Instruction to your Medicare Administrative Contractor (PDF). 

All Providers Updates

Medicare Physician Fee Schedule Database: October Update

See the instructions to your Medicare Administrative Contractor (MAC) (PDF) to learn about the October 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.

Electronic Health Records: Use Assistive Technology Correctly

Electronic health records (EHRs) may allow providers and suppliers to carry forward patient information from one visit to the next. This technology should only be used after you review and discuss information from the current visit and if it remains unchanged. Don’t solely rely on copied content without verifying continued accuracy because it can result in incomplete and inaccurate submissions that could affect coverage. Verify that all information you capture in the medical record accurately reflects your assessment, decision-making, and patient interactions. Conflicting information in a medical record can lead to claim denials, so ensure it’s up-to-date and accurate for the current visit.

For more information, see the Medicare Program Integrity Manual, Chapter 3 (PDF).

COVID-19 Vaccine: Updated Pricing for 2026–2027 Season

CMS updated COVID-19 vaccine payment allowances for the following CPT codes: 

91304

91319

91320

91321

91322

91323

Visit the Vaccine Pricing webpage for more information, including billing codes, short descriptors, payment allowances, and effective dates. Use the vaccine crosswalk (ZIP) if you need to identify the corresponding National Drug Codes.

Medicare Secondary Payer Claim Processing for Certain Claim Adjustment Reason Codes

Learn about claim processing updates (PDF):

Your Medicare Administrative Contractor (MAC) processes several Claim Adjustment Reason Codes (CARCs) systematically

CMS is directing Medicare Part A MACs and shared systems on which CARCs will process automatically and which MACs will suspend for manual review or deny

Recent Federal Investments To Expand Healthcare Services, Infrastructure, And Access Across Multiple States

Virginia ($122 Million): Supports rural health providers to expand access to care, workforce recruitment, and innovation.

Georgia ($93.3 Million): Focuses on expanding telehealth services, advancing surgical robotics, and strengthening the rural health workforce.

Ohio ($3.15 Million): Improves pharmacy connectivity and interoperability across rural communities to enhance patient care coordination.

Alaska ($160 Million): Funds cutting-edge medical technologies, prescription delivery via drones, and surgical robotics to improve infrastructure and access.

Alabama ($144 Million): Targets improvements in mental health, substance abuse treatments, emergency services, maternal care, and healthcare workforce expansion.

West Virginia ($4.2 Million): Expands medical transportation capacity to increase patient access to high-quality care across rural areas.

Indiana ($120 Million): Expands maternal and infant health services, increases primary care access, and grows the rural healthcare workforce.

Hawaii ($58 Million): Delivers new ambulances and upgrades emergency communications systems to improve rural emergency response and infrastructure.

Vermont: ($11.7 Million): Supports facilities to expand access to care, improve patient services, and strengthen healthcare infrastructure.

Arkansas ($149.3 Million): Expands telehealth technologies, specialty care access, and preventive screenings in rural areas.

Rhode Island ($5.48 million): Expands healthcare career training programs and strengthens the future rural healthcare workforce.

New York ($76 million): Strengthens regional healthcare coordination and modernizes healthcare technology to improve rural access to care.

Michigan ($25 million): Modernizes healthcare technology, expands telehealth access, and improves high-speed internet connectivity.

Educational Opportunities

Shape the Future of PAC Interoperability – Join Us at the September HL7 FHIR Connectathon

CMS, and the PACIO (Post-Acute Care InterOperability) Project invite healthcare information technology (HIT) vendors, facilities with their own EHRs and interested third parties to participate in the PACIO testing track at the upcoming HL7 FHIR Connectathon, taking place in person September 19-20, 2026, in Rockville, MD.

What’s Being Tested?

MITRE will test a potential interoperability-focused quality measure concept:  Interoperability Capability & Readiness Evaluation (I-CARE) for Post-Acute Care Settings. An early-stage quality measure concept for PAC settings, building on the feedback received through the Request for Information (RFI) included in the CY 2026 Home Health Prospective Payment System (PPS) rule.

Why Participate?

 Test real-world feasibility of I-CARE in your systems and workflows.

 Shape implementation before requirements are locked in.

 Provide direct feedback to CMS at the earliest stage possible.

Don’t miss this rare opportunity to help build a measure that works in the real world. Bring your expertise to the table — engage with the PACIO track at the September HL7 FHIR Connectathon.

Note: I-CARE is not a proposed or finalized measure. CMS is in an early, exploratory phase — and your feedback now will directly shape what comes next.

Key Details

*Event*	September HL7 FHIR Connectathon — PACIO Track 2026 – 09 PACIO IG Testing Track – FHIR – Confluence
*Dates*	September 19-20, 2026, in Rockville, MD.
*Participation Format*	In person; Member Early Bird : Member $670, Non-Member $820 After 8/21: Member $885, Non-Member $1035
*Registration Link/Deadline*	FHIR Connectathon
*Primary Contact*	James Patterson, MITRE Corporation \| jpatterson@mitre.org

CMS National Provider Enrollment Conference – November 18 & 19

Wednesday, November 18 & Thursday, November 19 in Orlando, Florida

Meet with provider enrollment experts from CMS, Medicare Administrative Contractors, and DME National Provider Enrollment Contractors. Visit the 2026 CMS National Provider Enrollment Conference webpage for more information. Registration opens in mid-September.

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.

Hospice

Home health

DMEPOS

Resources

New Health IT Resource Available – Introducing Cartos

Introducing Cartos – ONC’s public, FHIR-enabled terminology service that helps implementers find, understand, and use terminology content connected to ONC regulations and the Standards Version Advancement Process. It allows users to find up-to-date and correct terminology assets by bringing regulatory context, implementation guide references, terminology metadata, and terminology content together in one coordinated location.

Check out Cartos →