Literature Review

CMS clarifies telehealth policy during enrollment moratorium Hospice News; by Jim Parker; 5/21/26 Hospices will continue to be able to use telehealth for face-to-face recertifications during the hospice and home health enrollment moratorium, according to the U.S. Centers for Medicare & Medicaid Services’ (CMS). ... The federal statute stipulates that telehealth recertifications are not permitted in regions that are under an enrollment moratorium. This has raised some questions about how hospices can use telehealth for the next six months. “Perhaps the most troubling unintended consequence of a nationwide moratorium is its apparent impact on telehealth …” a trio of state associations said in a joint statement. “In rural communities and congested urban areas alike, this imposes severe and unnecessary burdens on the most vulnerable patients at the most vulnerable moments of their lives.”

Background on CMS’s anti-fraud efforts in hospice careAEI - The American Enterprise Institute; by James C. Capretta; 5/21/26 ... For broader context, Congress added hospice coverage to Medicare in the 1980s to provide lower-cost and more patient-centered settings for terminally ill beneficiaries. ... Like home health, the hospice benefit is vulnerable to abuse because the barriers to entering the market are lower than in more regulated settings. The capital investment to get started is minimal in comparison with building a new hospital, outpatient clinic, or nursing home. Further, the potential profit margins are high if a service provider is confident that the per diem is above what is needed to provide the required services.Although CMS’s focus on fraud in hospice care is warranted, stronger oversight by itself may not produce large program savings. In theory, more use of hospice care could lead to lower overall costs if the sponsoring agencies are competent and can help their patients avoid costly hospital or nursing home admissions. CMS’s investigations need to be subtle enough to weed out the bad actors without making it overly difficult for vulnerable patients to get the care they need in their own homes or in other low-cost community settings.

Loving Hands Hospice challenges Medicare payment suspension, cites due process concerns amid California hospice enforcement actions TMX Newsfile | Newsfile Corp., Los Angeles, CA; Press Release; 5/19/26 Loving Hands Hospice, a women-owned hospice care provider based in Los Angeles, California, has announced that it is currently involved in a legal dispute connected to Medicare payment suspension measures and related allegations under review (Reference Number: PSP-260330-00042). ... Loving Hands Hospice, which has provided hospice services to patients and families in the Los Angeles area for approximately five years, says it supports enforcement actions where legitimate fraud is identified. However, company leadership states that broad enforcement measures applied across California's hospice sector may not adequately account for differences in individual provider circumstances, patient populations, and compliance histories.

Ohio taking new steps to target Medicaid fraud Spectrum News 1, Cleveland and Columbus, OH; by Aliah Keller; 5/14/26Ohio is taking new steps to crack down on Medicaid fraud, with a focus on home-healthcare and hospice providers.What You Need To Know

Hospice fraud is becoming a political flashpoint. Why? National Public Radio WAMU; by Michelle Harven; 5/11/26 The state of California recently charged 21 people with hospice fraud, accusing them of costing the state $267 million. These types of schemes start with criminals opening up shell companies, signing recipients up without their knowledge, and then billing Medi-Cal for nonexistent services. This can have a serious effect on a senior’s ability to find care in the future. And it’s not just a state matter. The push to uncover this kind of fraud has become a political battle ... We sit down and talk about why we’re seeing this kind of fraud happen, who it harms, and why it’s become a political flashpoint.

Local hospice leader exposes fraud draining millions in taxpayer dollars across Texas KWTX 10, Waco, TX; by Nicole Marino; 5/8/26 Texas hospice licenses have nearly doubled since 2020, with some operators billing Medicare for patients who don’t know they’re enrolled. ... Lisa McNair, president and CEO of Hospice Brazos Valley, testified before the Texas Senate Committee on Health and Human Services in April with research showing the number of hospices in Texas has nearly doubled since 2020. There are now more than 1,300 hospices operating in the state. ... McNair told KBTX that the fraud is draining taxpayer dollars and eroding trust in legitimate end-of-life care.

CMS trains its program integrity sights on Texas Hospices JD Supra; by B. Scott McBride and Howard Young; 5/5/26 California has seen hundreds of hospice “takedowns” and Medicare payment suspensions targeting what the Centers for Medicare & Medicaid Services (CMS) proclaims are a multitude of fraudulent hospices, particularly in LA County. Now, based on recent public statements of CMS Administrator Dr. Mehmet Oz, it appears CMS is poised to train its sights on fraud, waste, and abuse among Texas hospice agencies.

CMS posts information on hospice election notification pilot: Crushing fraud, waste, & abuseCMS.gov; 5/1/26 On April 30, 2026, CMS announced that they had expanded the Hospice Election Notification pilot from Nevada into California.  During the pilot, when a hospice provider files a Notice of Election, a notification letter is immediately sent to the beneficiary to make sure they know they have been enrolled in hospice. If they did not enroll, they are instructed to call 1-800-MEDICARE who can help with overturning the election. Since the start of the pilot in Nevada in May 2025, more than 25,000 letters have been issued.  A copy of the letter being sent to beneficiaries in these states is available here.

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.