OneCare Hospice, LLC has been kicked out of Medicare after a federal administrative law judge upheld a government move to cut off the Las Vegas company, not because its own claims were found fraudulent, but because of its legal ties to another Nevada hospice that had already lost its billing privileges. On top of the revocation, OneCare is staring at a 10-year Medicare reenrollment bar and a spot on the Centers for Medicare & Medicaid Services’ Medicare preclusion list.
The decision, issued July 9 after OneCare appealed the earlier agency action, found that federal officials were within their rights to pull OneCare’s enrollment. HHS said the affiliation with PHHC of Nevada LLC created an “undue risk of fraud, waste, or abuse” to the Medicare program under existing federal rules.
The trouble started at PHHC, which was treated as a new provider and placed into CMS’s heightened review track. Federal reviewers scrutinized 10 hospice claims submitted between Nov. 27, 2024, and Jan. 31, 2025, and denied nine of them because the records did not support a terminal prognosis of six months or less, according to KTNV. Separately, CMS notes that hospice is a Medicare Part A benefit for terminally ill patients and lists Nevada among the states facing extra program-integrity scrutiny…