Literature Review

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. 

The most connected hospice doctor in California CBS News Investigations; by Laura Geller, Rachel Gold, Adam Yamaguchi and Grace Manthey; 4/7/26 Physicians who oversee hospice clinics deliver a critical and delicate form of care to patients confronting terminal illness with the goal of helping them find dignity and comfort at the end of life. No active physicians oversaw more of these cases in California, or were reimbursed with more taxpayer money, than Dr. Rajiv Bhuva, according to federal records. ... Bhuva's name was listed on reimbursements for at least 2,800 patients across 126 California hospices in 2024. ... While fraud in the hospice industry is a long-running and complex problem, the role of physicians – knowingly or unwittingly facilitating it – has largely gone overlooked. 

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]

CMS clarifies hospice revocations, face-to-face encounters McKnights Home Care; by Suzy Frisch; 3/24/26 If a hospice patient is discharged from care or has their benefits revoked, they do not have to complete a waiting period to arrange for new care, according to the Centers for Medicare & Medicaid Services, which provided such clarifications earlier this month. If a hospice patient is discharged from care or has their benefits revoked, they do not have to complete a waiting period to arrange for new care, according to the Centers for Medicare & Medicaid Services, which provided such clarifications earlier this month. 

Larchmont woman sentenced to nearly 3 years in federal prison for her role in hospice and diagnostic testing fraud that conned Medicare United States Attorney's Office - Central District of California, Los Angeles, CA; Press Release; 3/24/26 A woman from the Larchmont area of Los Angeles was sentenced today to 35 months in federal prison for defrauding Medicare out of more than $14 million by submitting fraudulent claims for hospice care and diagnostic testing services that were either unnecessary or not provided at all. Sophia Shaklian, 38, was sentenced by United States District Judge Stanley Blumenfeld Jr., who also ordered her to pay $14,103,043 in restitution. Shaklian pleaded guilty in November 2025 to one count of health care fraud.

CMS implements enhanced oversight for MAC MBI lookup tools Hospice News; by Jim Parker; 3/17/26 ... In response to a rise in these fraudulent activities, CMS has strengthened oversight of Medicare Administrative Contractor (MAC) MBI lookup tools. The agency now monitors MBI searches against submitted claims using National Provider Identifiers (NPIs). Access to these tools may be revoked if providers conduct a high volume of lookups without submitting corresponding claims. This move by CMS is likely an important step in combatting fraud, according to Sheila Clark, president and CEO of the California Hospice and Palliative Care Association (CHAPCA).

How closed-ended survey questions and narrative comments interact in characterizing caregivers’ overall assessment of hospice care Rand.org, published in American Journal of Hospice and Palliative Medicine; by Denise D. Quigley, Anagha Alka Tolpadi, Danielle Schlang, Joshua Wolf, Rebecca Anhang Price, Melissa A. Bradley; April 2026 online ahead of  print Introduction: Responses to open-ended questions on experience surveys provide rich information and are useful for quality improvement (QI). We examine the usefulness of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey comments for informing hospice QI.Conclusion: Closed-ended questions on the CAHPS Hospice Survey elicit comprehensive insights on hospice care experiences. While many caregivers elected to provide open-ended feedback, a minority of these comments were actionable for QI, and comments did not provide substantial, unique information. CAHPS Hospice Survey measures are sufficient, without open-ended comments, to guide QI, prioritize actions, benchmark performance and assist caregivers in hospice selection.

Aetna agrees to pay $117.7 million to resolve false claims act allegationsDOJ press release; 3/11/26Aetna Inc., a national insurer incorporated under the laws of Pennsylvania, has agreed to pay $117,700,000 to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare.