Complete Story
05/05/2026
Federal Fraud Enforcement Expands Again - What’s Different Now
Federal scrutiny of hospice and home health isn’t slowing down - it’s evolving.
In the past two weeks, regulators have taken additional steps to strengthen enforcement, including launching a new West Coast Health Care Fraud Strike Force and continuing aggressive use of payment suspensions tied to suspected fraud activity.
What’s different this time
This isn’t just about more audits. The approach itself is shifting.
Federal agencies are coordinating enforcement across DOJ and HHS-OIG
Payment suspensions are being used earlier in investigations
Data signals like live discharge rates are driving reviews
Industry leaders are raising concerns that some enforcement actions may rely heavily on limited data points, which could unintentionally pull compliant providers into investigations.
Why it matters
Even if your organization is fully compliant, this environment creates real operational risk:
Payment suspensions can halt reimbursement during an investigation
Increased scrutiny can make referral sources more cautious
Increased audits and documentation requests add administrative burden
Enforcement trends in other states often inform future national strategy
Ohio providers are already seeing increased oversight activity - this signals that trend is not slowing down.
What to do now
Review live discharge rates, length of stay, and utilization patterns
Ensure documentation clearly supports eligibility and certifications
Prepare for ADRs, audits, and potential payment holds
Align clinical and billing documentation