What's New

November 5, 2025

2025 Top Unimplemented Recommendations

October 30, 2025

South Carolina Did Not Comply With Federal Waiver and State Requirements at 19 of 20 Adult Day Care Facilities A-04-24-00137

Medicare Home Health Agency Provider Compliance Audit: VNA Care Network A-05-22-00016

October 29, 2025

CMS’s Special Focus Facility Program for Nursing Homes Has Not Yielded Lasting Improvements OEI-01-25-00050

Enforcement Actions

November 3, 2025; U.S. Attorney's Office, Western District of Tennessee

Federal Grand Jury returns Second Superseding Indictment against Memphis Gynecologist

September 26, 2025; U.S. Attorney's Office, District of New Jersey

Owner of Mail Order Pharmacies Settles False Claims Act Investigation Involving Allegations of Fraudulent Billing Practices and Kickbacks

What's Trending

1. Medicare Advantage Risk-Adjustment Data - Targeted Review of Documentation Supporting Specific Diagnosis Codes
2. Medicare Improperly Paid Suppliers $22.7 Million Over 7 Years for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided to Enrollees During Inpatient Stays
3. Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health and Life Insurance Company (Contract H1608) Submitted to CMS
4. CMS’s Special Focus Facility Program for Nursing Homes Has Not Yielded Lasting Improvements
5. Submit a Hotline Complaint