Specialty Focus 4/7/26: Hospice fraud in the spotlight + West Virginia tackles prior authorization

April 7, 2026 | Volume XV | Issue 14

Hospice fraud in the spotlight

CBS News reports:

The FBI arrested a married couple Thursday accused of fraudulently billing Medicare for $7.45 million while running a hospice with a survival rate reported to be more than 97% after five years. They were the first in a series of arrests planned Thursday, federal officials told CBS News.

A high survival rate at a hospice provider is one of a series of red flags identified by state auditors for fraud because most people enter hospice care in the final stages of a terminal illness. In past cases of fraud, operators were found to be using false or stolen identities...

West Virginia tackles prior authorization

Lauren Sausser

Six months after a West Virginia man died following a protracted battle with his health insurer over doctor-recommended cancer care, the state’s Republican governor signed a bill intended to curb the harm of insurance denials.

West Virginia’s Public Employees Insurance Agency enrolls nearly 215,000 people — state workers, as well as their spouses and dependents. The new law, which will take effect June 10, will allow plan members who have been approved for a course of treatment to pursue an alternative, medically appropriate treatment of equal or lesser value without the need for another approval from the state-based health plan.

“This legislation is rooted in a simple principle: if a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to start the process over again — especially when it does not cost more,” Gov. Patrick Morrisey said in a statement after signing the bill into law on March 31.

Restoring balance to the No Surprises Act

(Editor's note: Catherine Gaffigan is an executive at Elevance Health.)

Fierce Healthcare delivers Opinion by Dr. Catherine Gaffigan:

Recent commentary from certain hospital groups may lead you to believe that we are trying to make healthcare harder to access and more expensive through our non-participating provider facility administrative policy.

While that makes for a good headline, it couldn’t be further from the truth.

The purpose of this policy is to ensure that patients have access to care they need at a cost that families and employers can afford.

What to know about ‘Cicada,’ the new COVID-19 variant

PBS News

There's a new COVID variant in town. It's called "Cicada," and experts in the U.S. are on alert as it gains traction.

The official name of the variant is BA.3.2. It first appeared in 2024 in South Africa and was identified in the U.S. in the summer of 2025. It went dormant, much like its namesake insect, before resurfacing again in the U.S. around the new year.

"Cicada" is part of the omicron family, so it is similar to other recent variants. But it has a lot of mutations, making it harder for previous versions of the COVID vaccine to keep up against infection.

View video HERE.

Last Word

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