Literature Review

Alliance sounds alarm over federal payment suspensions tactic to fight hospice fraud McKnights Home Care; by Liza Berger; 5/1/26 As the federal government continues to crack down on rampant hospice fraud in California and other states, advocates for the field fear that the government’s latest enforcement effort is unintentionally trapping ethical providers. ... While the government is basing a payment suspension on “a credible allegation of fraud,” the National Alliance for Care at Home worries that the government is using just one metric to justify its “credible allegation.” ... In a post this week, law firm Foley & Lardner LLP CMS defined a “’credible allegation of fraud’ as an allegation of fraud from any source, including but not limited to the following: (1) fraud hotline tips ... verified by further evidence; (2) claims data mining; and (3) patterns identified through provider audits, FCA cases and investigations.”

Kansas veteran dies in hospice weeks after KWCH story on cancer fight, push for health benefits KWCH-12 News, Wichita, KS; by Matt Heilman and KWCH Staff; 4/28/26 A Kansas veteran whose story 12 News shared last month following the initial denial of her VA health benefits amid her cancer battle died Monday night in hospice care, her husband confirmed. Lorraina Robles, who served in the Air National Guard, most recently in Africa, fought stage 3 cervical cancer for over a year. Adding to the difficulty, her VA benefits for cancer treatment and other health benefits were denied following her return from deployment. 

Seven key moments: hearing on Medicare fraud United States House Committee on Ways & Means, Chairman Jason Smith, Washington, DC; Press Release; 4/27/26 [This is the official post from Rep. Jason Smith, Chairman  of the U.S. House Committee on Ways & Means.] Medicare fraud is a massive problem that costs taxpayers $60 billion every year and denies Americans access to their Medicare beneficiaries.

CMS educational video: Hospice levels of care and how to bill for service intensity add-on (SIA) payments CMSHHSgov YouTube and CMS MLN Connects Newsletter; posted on CMS's YouTube channel 4/17/26, posted in CMS MLN Connects Newsletter 4/23/26 This video is intended to educate hospices on a service opportunity called a service intensity add-on payment. Hospice agencies are paid a daily rate for each patient enrolled in hospice regardless of the number of services provided on a given day, including days when hospice provides no services. Hospice benefits allow hospices to bill an additional payment on an hourly basis for registered nurse and social worker visits during the last seven days of a patient’s life in addition to their standard daily reimbursement.

How a pickleball injury highlights fraud in California's hospice industry ArcaMax; by Richard Winton; 4/21/26 Lynn Ianni didn't learn she was apparently dying in a Los Angeles County hospice care facility until her Medicare claim for a pickleball injury was rejected. "At first we laughed because it was an obvious clerical error," the Seattle-based psychotherapist recalled before a congressional committee Tuesday, where she was providing testimony about her months-long experience in 2024 with fraud in the hospice industry. "It wasn't just frustrating, it was terrifying." Ianni appeared before the House Ways and Means Committee on Capitol Hill at a hearing that revealed details about fake claims and stolen doctors' identities. She was a victim of California hospice scammers. 

Carve-in or carve-out? The future of hospice under Medicare Advantage | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Robin Hefferman; 4/15/26In Part One of this thought-provoking conversation, Chris Comeaux and Robin Heffernan, PhD, Co-Founder and CEO of Empassion, explore the evolving intersection of private equity, artificial intelligence, and end-of-life care—raising critical questions about accountability, quality, and the future of hospice under Medicare Advantage. As the healthcare system shifts toward value-based models, the discussion challenges long-held assumptions about whether hospice should remain “carved out” or be fully integrated into payer responsibility.

Hospices to face increased scrutiny under new scoring system Harris Beach Murtha Attorneys at Law; by Glenn M. Jones and Roy W. Breitenbach; 4/15/26 The Centers for Medicare & Medicaid Services (CMS) plans a new hospice scoring system in fiscal year 2027 . ... CMS announced the service and spending variation index (SSVI) is part of its ongoing efforts to combat fraud and strengthen program integrity. CMS said the system will increase transparency for families, ensure proper care, protect beneficiaries and support providers delivering quality end-of-life care. Details of the proposed rule can be found on the Federal Register. The agency has also published a fact sheet on the proposed rule. The SSVI score will be based on a variety of metrics CMS gathers from hospice claims, including:

Hundreds of hospice providers suspended in Los Angeles over $600 million in suspected fraud Washington Examiner; by Mia Cathell; 4/15/26 Vice President JD Vance's anti-fraud task force has suspended hundreds of hospices suspected of fraudulently billing for end-of-life services in Los Angeles, an area identified by both state and federal authorities as a hospice fraud hot spot. The newly appointed White House task force, headed by Vance, issued suspensions this week against 447 hospices and 23 home health agencies operating out of Los Angeles, pausing payments to providers believed to have defrauded federal healthcare programs out of more than $600 million.

Inside California’s hospice gold rush: the state’s IHSS program is losing between 20%-40% of its entire budget to fraudDeseret News; by Eva Terry; 4/14/26 An investigative report details large-scale hospice and in-home care fraud in California, where transnational criminal networks have billed the state for over $267 million in non-existent services. The state’s In-Home Supportive Services (IHSS) program is estimated to be losing 20–40% of its entire budget to fraud, prompting Governor Newsom’s administration to revoke hundreds of hospice licenses and make arrests. Despite state actions, over 700 active hospices in Los Angeles alone have triggered multiple red flags for fraud.Guest Editor's Note, by Judi Lund Person: Today's biggest developing thread remains the rumored national moratorium on new hospice Medicare enrollment. Hospice News reported on April 13 that questions are circulating in the industry about whether CMS is preparing a nationwide enrollment freeze for hospice providers, following a public push by state associations urging the agency not to do so. That story, combined with the ongoing California fraud crackdown and the FY 2027 proposed rule's new SSVI scoring system, paints a picture of an hospice care under enormous regulatory pressure on multiple fronts. 

CMS issues guidance to implement new limits on federal Medicaid and CHIP funding for certain noncitizens CMS Newsroom; Press Release; 4/8/26 CMS is preparing states for an upcoming change that will limit the ability to claim federal matching funds for Medicaid and the Children’s Health Insurance Program (CHIP) for individuals who are not U.S. citizens or U.S. nationals, or who fall into specific noncitizen categories identified in statute. New guidance issued today will ensure states understand their responsibility in implementing this statutory change beginning October 1, 2026. ... To view the State Health Official (SHO) letter, visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf.

LACo Board presses for stepped-up enforcement of hospice, home care fraud MyNewsLA.com; by Contributing Editor; 4/7/26 The county Board of Supervisors directed its staff Tuesday to develop recommendations aimed at improving coordination with other agencies to crack down on home health and hospice fraud. “Fraud in home health and hospice care is not just a financial crime — it is a direct threat to the health and safety of some of our most vulnerable residents,” Supervisor Lindsey P. Horvath said in a statement after the board’s unanimous vote. 

California targeted in House Committee investigation of hospice fraud

HHS and CMS announce Healthcare Advisory Committee members to improve patient care and modernize the U.S. healthcare system CMS Newsroom; Press Release; 3/26/26 The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the members of the Healthcare Advisory Committee, a new federal advisory body comprised of leaders from across the healthcare system to provide expert advice on improving, strengthening and modernizing U.S. healthcare. The Committee will advise HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz on ways to improve how care is financed and delivered across Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. [Access the list]