Literature Review

NPHI execs: quality is hospices’ differentiator Hospice News; by Jim Parker; 4/28/26 True quality care transcends government-required metrics and is key to shaping the future of hospice care. This is according to Tom Koutsoumpas, founder and CEO of the National Partnership for Healthcare & Hospice Innovation (NPHI), and Carole Fisher, the organization’s president. While factors like regulatory compliance are crucial to quality, they don’t tell the whole story, Koutsoumpas and Fisher told Hospice News at NPHI’s Annual Summit in Chicago. “Quality is our differentiator. In addition to all the scores, certainly patient and family satisfaction is a huge part of it, making sure that we continue to put the patient and family in the center. ...” Koutsoumpas said. “Do we create an atmosphere of trust? That’s a quality issue."

Researchers at University of Pittsburgh target managed care (The state of hospice: Impacts on equity, quality, and nursing-an AAN consensus paper): managed care Insurance Newsnet; by a news reporter-staff news editor at Insurance Daily News; 4/24/26 ... This consensus paper examines the current state of hospice care in the US and the impact of changing hospice business models on health equity, healthcare quality, and nursing practice. Review of current literature and government policy statements related to hospice care and payment. Recommendations include updating policies to account for private equity involvement, evaluating current quality measures, addressing the existing Medicare Hospice Benefit, ensuring transparency and oversight for hospice agencies, and ensuring patient and caregiver education about hospice services.

Tom Koutsoumpas: California’s hospice fraud crisis demands action Redlands Daily Facts | Commentary; by Tom Koutsoumpas; 4/23/26 Throughout the 1980s, in the early days of building hospice care into the American healthcare system, those of us on the frontlines helped shape what would become the Medicare hospice benefit. It was a turning point in how this country cares for people at the end of life. At its core, the hospice benefit is simple. ... For millions of families, it has meant more dignity, more support, and more time focused on what matters most. That’s why the scale of fraudulent hospice activity in California is so deeply concerning. This is not a gray area. It is widespread fraud, targeting vulnerable patients and exploiting gaps in oversight.

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.

AAHPM Hospice Statement approved by the Executive Committee on April 17, 2026 American Academy of Hospice and Palliative Medicine; Press Release; 4/17/26 The AAHPM Executive Committee of the Board of Directors, in close coordination with Academy staff and trusted stakeholder partners, has been actively monitoring and discussing recent events and actions, including those by the U.S. Department of Justice (DOJ), Department of Health and Human Services (HHS), as well as Congressional hearings related to hospice fraud. ... The Centers for Medicare and Medicaid Services (CMS) should target fraudulent hospices. We have provided guidance to CMS on our recommendations to do so with precision, including but not limited to identifying red flags such as those below, which should be applied with clinical context and should not be applied mechanically to penalize providers serving complex patient populations. [Continue reading]

New research shows earlier hospice election could save Medicare over $1 billion annually National Alliance for Care at Home, Alexandria, VA; Press Release; 4/23/26 A new analysis commissioned by the Research Institute for Home Care (the Institute) reveals that if Medicare beneficiaries elected hospice care just five days earlier, the program could save between $1.19 billion and $1.5 billion annually.  The analysis, conducted by ATI Advisory, demonstrates how modest, clinically appropriate changes in hospice timing could generate significant Medicare savings while improving patient outcomes. These findings are particularly relevant as Medicare spending on hospice services increases by nearly 10% annually, and overall enrollment of Medicare beneficiaries using hospice continues to grow.

NPHI statement on “Protecting Patients and Taxpayers: Cracking Down on Medicare Fraud” hearingNational Partnership for Healthcare and Hospice Innovation, Washington, DC; Press Release; 4/22/26 The National Partnership for Healthcare and Hospice Innovation (NPHI) supports the continued focus by Congress and the Administration on addressing fraud, waste, and abuse within the Medicare hospice benefit. NPHI’s policy team, led by Ethan McChesney and joined by Quin Lyons, attended the House Ways & Means Full Committee hearing titled “Protecting Patients and Taxpayers: Cracking Down on Medicare Fraud,” on April 21, reinforcing NPHI’s active engagement on this issue. ... “Fraud in hospice is not a theoretical concern – it is happening in real time, and patients and families are paying the price,” said Tom Koutsoumpas, Founder and CEO of NPHI. “We are seeing entire markets impacted by actors who have no connection to the communities they claim to serve. These fraudulent actors must be rooted out of the system — at once.

Hospice Fraud Briefing: one page summaryLund Person & Associates Hospice Consulting; by Judi Lund Person; 4/16/26 Download this one-page, detailed summary of Top Cases, Total Losses, and Dominant Schemes from April 2025-2026.

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.