The Sixth Circuit Court of Appeals has ruled on a significant case affecting hospice service providers and their reimbursements under Medicare. In Home Health, LLC, a Medicare-certified hospice provider, challenged a decision that denied coverage for certain claims. The court's ruling impacts how hospice providers can qualify for Medicare reimbursement, particularly in cases where the terminal prognosis of patients is in question.

The case, In Home Health, LLC v. Robert Kennedy, Jr., was filed under docket number 25-3542. The court's decision, issued on July 27, 2026, involved an appeal from In Home Health against the Secretary of the United States Department of Health and Human Services. This ruling is crucial because it clarifies the standards that hospice providers must meet to qualify for Medicare's safe harbor provisions when disputing coverage denials.

BACKGROUND

In Home Health, LLC is a provider of hospice services that operates under Medicare guidelines. The dispute began when a Medicare contractor reviewed claims from In Home and determined that 252 of 374 claims did not meet coverage requirements, resulting in nearly $1 million in overpayments that In Home was required to repay.

In Home Health appealed the contractor's decision through a multi-step administrative process. After an unfavorable outcome at several stages, including a hearing with an Administrative Law Judge (ALJ), In Home Health sought judicial review. The ALJ upheld many of the contractor's denials, stating that In Home should have known the standards for sufficient documentation and billing practices. This led to In Home Health appealing to the district court, which affirmed the ALJ's decision.

THE RULING

The Sixth Circuit Court, led by Judge Rachel S. Bloomekatz, ruled that the ALJ had erred in applying the safe harbor provision of the Medicare statute. The court stated, “the ALJ should have asked whether In Home adopted a reasonable interpretation of the operative Medicare notice as applied to relevant claims.” This ruling indicates that the ALJ's conclusion that In Home Health was liable for the denied claims was based on an incorrect standard.

The court vacated the previous decisions and remanded the case back to the district court, instructing it to return the case to the ALJ for further evaluation under the proper legal standard regarding the safe harbor. The court emphasized that the ALJ should consider whether In Home Health could reasonably have interpreted the Medicare notices and standards as covering the disputed claims.

IMPACT

This ruling has significant implications for hospice providers across the country. It clarifies that providers may not be held liable for overpayments if they can demonstrate that their interpretation of Medicare standards was reasonable, even if it was incorrect. This change aims to protect providers from undue financial burdens when they act in good faith while navigating the complexities of Medicare regulations.

The decision also sets a precedent for how ALJs should evaluate claims in the future. It underscores the importance of assessing whether providers had a reasonable basis for their interpretations of Medicare coverage standards, rather than simply assuming they were aware of the standards and denying their claims based on that knowledge.

WHAT'S NEXT

The case will return to the ALJ for further review, where the standard set by the Sixth Circuit will be applied to In Home Health's claims. The outcome of this remand process will determine whether In Home Health will be required to repay the denied claims or if they will receive the reimbursements they seek.