Literature Review

CMS targeting Georgia, Ohio in fraud fight Hospice News; by Jim Parker; 5/22/26 Ohio and Georgia are seeing a large influx of new hospice operators, leading some to suspect that fraud is becoming more prevalent in those states. The four states that historically have been hotbeds for fraud — California, Arizona, Nevada and Texas — also saw hosts of new providers enter their markets, many of which were malfeasant. Among other efforts to combat the ongoing fraud, the U.S. Centers for Medicare and Medicaid Services (CMS) in 2023 instituted a provisional period of enhanced oversight for those four states. That has now been extended into Georgia and Ohio, retroactive to Dec. 31, 2025.

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.”

The state of hospice: Impacts on equity, quality, and nursing-An AAN consensus paperNursing Outlook; by Laura Fennimore, Kathleen O Lindell, Marjorie M Godfrey, Melissa Reider-Demer, Patrick J Coyne, Ronda G Hughes, Sharon Kozachik, Masako Mayahara, Patricia L Thomas, Nelson Tuazon, Polly Mazanec; 4/26Hospice care has been an integral component of the United States healthcare system for over fifty years. Hospice has transitioned from a volunteer activity supported by philanthropy to a highly sophisticated business funded by Medicare, increasingly offered by for-profit and private equity companies. 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. 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. These recommendations aim to preserve the fundamental values of hospice, supporting compassion, dignity, and comfort while ensuring the quality of care to patients and families in need.

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.

CMS’s nationwide moratorium on new hospice and home health enrollments: operational, transactional, and enforcement risks for existing providers, healthcare organizations, and investorsClark Hill; by Jose Vela Jr.; 5/19/26 ... Key Takeaway: The larger issue may no longer be whether fraud exists within isolated hospice or home health agencies. ... Healthcare organizations, investors, healthcare professionals, and operational leaders affiliated with hospice and home health providers may wish to evaluate ownership structures, pending transactions, enrollment status, billing practices, referral relationships, operational controls, reimbursement exposure, and existing government scrutiny before operational disruptions, payment suspensions, recoupment activity, or enforcement actions arise.

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

The National Law Review: CMS imposes nationwide enrollment moratoria on hospices and home health agencies - what buyers sellers and operators need to know The National Law Review; by Margia Corner, Ashley Wheelock, Tammy Ward Woffenden, Sheppard, Mullin, Richter & Hampton LLP; 5/14/26 ... [Assuming readers have background information] ... Critically for some pending or proposed transactions, both moratoria block re-enrollment of hospices or HHAs undergoing a non-exempt change in majority ownership (CIMO) within 36 months of initial enrollment or the most recent CIMO. Such transactions require the entity to enroll as a brand-new provider.... Both moratoria apply only to Medicare. However, CMS is encouraging states to consider parallel moratoria for Medicaid and CHIP, tailored to their beneficiary population and geographic considerations. CMS also noted that while some states previously enacted laws placing a moratorium on issuing new licenses in their state, those efforts cannot prevent new agencies or enrollments in other states and thus its nationwide moratoria are warranted.

US halting Medicare enrollments for new home healthcare and hospice providers Reuters; by Jody Godoy; 5/13/26 The Trump administration will temporarily block new home health and hospice providers on Wednesday from enrolling in Medicare, a senior administration official said, citing concerns about widespread fraud. The nationwide moratorium is the latest move by Vice President JD Vance's anti-fraud task force to crack down on healthcare scams, including those that affect Medicare, a U.S. government program providing health insurance to elderly and disabled Americans.

US halting Medicare enrollments for new home healthcare and hospice providers Reuters; by Jody Godoy; 5/13/26 The Trump administration will temporarily block new home health and hospice providers on Wednesday from enrolling in Medicare, a senior administration official said, citing concerns about widespread fraud. The nationwide moratorium is the latest move by Vice President JD Vance's anti-fraud task force to crack down on healthcare scams, including those that affect Medicare, a U.S. government program providing health insurance to elderly and disabled Americans.

HOPE is raising the stakes for hospice compliance HealthIT Answers; by Michelle Barlow, RN, BSN; 5/11/26 Hospice providers are entering a tougher regulatory environment. ... At the center of these changes is the Hospice Outcomes and Patient Evaluation (HOPE) tool, which replaced the Hospice Item Set in October 2025. ...

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.