HealthBridge US Issues Press Release on Expanded CMS Hospice Oversight

FOR IMMEDIATE RELEASE

HealthBridge US Issues Press Release on Expanded CMS Hospice Oversight
Los Angeles, California | January 13, 2026

HealthBridge US announces that, in December 2025, the Centers for Medicare & Medicaid Services (CMS) expanded enhanced oversight measures to include hospice providers operating in Georgia and Ohio. Under this action, hospices in these states are now subject to the Provisional Period of Enhanced Oversight (PPEO) and Expanded Prepayment Review (EPR) programs.

These oversight programs place affected hospice providers under heightened federal review, including prepayment medical review of Medicare claims. Georgia and Ohio join Arizona, California, Nevada, and Texas, where hospice providers are already operating under similar CMS-directed oversight frameworks. CMS has stated that the expansion reflects its continued emphasis on hospice program integrity and regulatory enforcement.

Overview of PPEO and EPR Programs

PPEO and EPR are oversight mechanisms used by CMS to closely examine hospice provider enrollment activity and Medicare billing practices during designated review periods. Under these programs, Medicare claims may be held prior to payment while medical documentation is reviewed to determine compliance with hospice coverage and payment requirements. Based on review outcomes, CMS may issue claim denials or pursue further administrative actions affecting Medicare billing privileges.

Circumstances Associated With Enhanced Oversight

CMS and its Medicare Administrative Contractors apply PPEO and EPR based on identified risk indicators. Circumstances commonly associated with enhanced oversight include new Medicare enrollment, changes of ownership that meet regulatory thresholds, and material enrollment events such as reactivations or significant updates. The scope and duration of oversight may vary based on CMS directives and contractor implementation.

Operational Impact on Hospice Providers

During prepayment review, selected claims are suspended while additional documentation is requested and evaluated. Payment determinations are issued only after the review process is completed. CMS-authorized medical review activity may continue beyond the formal oversight period depending on findings. Hospice providers retain administrative appeal rights related to claim determinations and enrollment actions.

Statement From HealthBridge US

Albert Ogannisyan, Vice President of Clinical Operations at HealthBridge US, stated:
“This expansion underscores CMS’s continued focus on hospice program integrity and regulatory oversight. As enforcement intensifies, proactive compliance is no longer optional. Maintaining and clearly documenting ongoing clinical eligibility is a critical operational and financial imperative for hospice providers.”