Literature Review

READOUT: FinCEN holds engagement to eliminate hospice fraud in CaliforniaU.S. Treasure Financial Crimes Enforcement Network, Los Angeles, CA; 8/19/26 On August 17, the U.S. Department of the Treasury’s Financial Crimes Enforcement Network (FinCEN) convened law enforcement and financial institutions for an engagement on health care benefits fraud, including the exploitation of hospice care services. Participants discussed new and emerging health care fraud schemes targeting federal and state health insurance programs, associated financial typologies and red flag indicators, and opportunities to boost awareness around hospice care fraud. Additionally, FinCEN held a training session for law enforcement on August 18 on how to use Bank Secrecy Act data to combat fraud. These engagements build on FinCEN’s work to counter fraud in partnership with the White House Task Force to Eliminate Fraud. 

Nearly one in five Medicare hospice patients now leaves the program alive rather than through death Medical Daily; by Dorothy Brooks; 8/17/26 Almost one in five people who leave Medicare hospice care each year leaves alive rather than through death, and the share has climbed every year since 2021. Federal data released this spring put the live discharge rate at 19.1 percent in fiscal year 2025, up from 16.9 percent four years earlier. For families, this is the rule almost nobody explains at enrollment. Hospice is not a permanent placement. It is a benefit tied to a prognosis, and when that prognosis changes, the benefit can end while the patient is still living, still ill, and still needing care. Understanding it before it happens is the difference between a planned transition and a phone call that lands like an eviction.

Nearly one in five Medicare hospice patients now leaves the program alive rather than through death Medical Daily; by Dorothy Brooks; 8/17/26 Almost one in five people who leave Medicare hospice care each year leaves alive rather than through death, and the share has climbed every year since 2021. Federal data released this spring put the live discharge rate at 19.1 percent in fiscal year 2025, up from 16.9 percent four years earlier. For families, this is the rule almost nobody explains at enrollment. Hospice is not a permanent placement. It is a benefit tied to a prognosis, and when that prognosis changes, the benefit can end while the patient is still living, still ill, and still needing care. Understanding it before it happens is the difference between a planned transition and a phone call that lands like an eviction.

How SNF upper payment limits can hurt hospices Hospice News; by Brandyn Simmons; 8/17/2 When it comes to healthcare — especially if it involves Medicare or Medicaid — one solution can lead to new problems. The Upper Payment Limit (UPL) program is no exception to this rule. Across the spectrum in healthcare, Medicaid reimbursements have typically been inadequate in covering all expenses for patient care. This is where the UPL comes in. Under this initiative, providers such as skilled nursing facilities (SNF) can receive a gap payment through Medicare to make up the difference. While this is a boon for SNFs, this can become a major headache for many hospice companies across the United States. ...

DOJ’s National Fraud Enforcement Division announces priorities ReedSmith; by Scot T. Hasselman, Selina P. Coleman, Matthew K. Loughran; 8/14/26 In an August 13 memo, Assistant Attorney General Colin M. McDonald set forth the priorities of the Department of Justice (DOJ) National Fraud Enforcement Division that will be focused primarily on criminal public benefits fraud and misuse of taxpayer dollars. In the health care space, the primary targets in include home health agencies and hospice providers, as well as pharmacists and physicians who may be involved in drug diversion. ... The McDonald memo details some of the efforts that the division will focus on when attempting to combat health care fraud. According to the memo, approximately 3 to 10 percent of all health care spending is the result of fraud. ... While the McDonald memo has limited details, it breaks down four other specific categories of fraud that the division will seek to prosecute.

California’s new emergency hospice regulations: key requirements for providers JD Supra; by Margia Corner, Elicia Grilley Green, Lena Zinner; 8/13/26 For the first time in California’s history, hospice agencies have become subject to comprehensive hospice-specific licensing regulations adopted on an emergency basis and effective June 22, 2026. ... The new regulations apply to both existing licensees and new applicants, add significant new requirements for CDPH approval of transactions and other operational changes, such as the licensee’s physical location, and authorize CDPH to conduct unannounced inspections to verify compliance. Providers would benefit from reviewing their operations against the new requirements below.

Can a short-term moratorium strengthen the hospice sector? LeadingAge; by Katie Smith Sloan; 8/11/26 President and CEO Katie Smith Sloan explains why LeadingAge supported the six-month moratorium on Medicare enrollment of new hospice providers and what nonprofit providers can do to strengthen the hospice sector.Earlier this year, I had the opportunity to attend a community theater production of the iconic musical “Fiddler on the Roof.” In a series of unforgettable scenes, Tevye, the production’s main character, makes difficult family decisions by artfully balancing opposing views before choosing his path. “On the one hand,” he intones, then ruminates on the important role tradition must play in the life of his village and family. “On the other hand,” he counters thoughtfully, then acknowledges that the inevitability of change must be factored into every decision.I’ve recalled Tevye’s internal monologue many times since May, when the Centers for Medicare and Medicaid Services (CMS) announced a six-month national moratorium on enrolling new hospice agencies in Medicare. ...

How California’s hospice industry spiraled out of control — and cost millions in fraud Los Angeles Daily News, Los Angeles, CA; by Jason Henry; 8/9/26 A quiet change in California law in 2018 unleashed a deluge of new hospices and spurred millions of dollars in Medicare fraud that state and federal authorities are still trying to unwind. ... It all started with three paragraphs added, at the request of the California Department of Public Health, to the end of an omnibus bill in 2018. CDPH had a backlog of 72 applications for hospice licenses at the time and wanted legislators to provide an alternative to a major bottleneck: its own inspectors. Under SB 1495, hospices could choose to pay a third-party accrediting organization for the inspection needed for a license, instead of waiting weeks or months for the next available state employee. ... Unlike a restaurant, which must undergo fire, building and health inspections, the vast majority of hospices in California could suddenly obtain a license, and even approval to bill Medicare, without a public employee stepping foot on the property. ...

Home health, hospice admissions surge as Medicare Advantage growth plateausMcKnights Home Care; by Marissa Fernandez; 8/6/26  Providers could potentially have a new benchmark for fee-for-service home care admissions, according to the latest report from Trella Health. The annual interactive Post-Acute Market Intelligence Report: 2026 Edition also found increases in home health and hospice admissions, as well as other related data changes that could signal national trends.

Hospice Coalition Questions and Answers: June 25, 2026Palmetto GBA; 8/4/26Includes Coalition questions, Hospice Appeals Reports, and Hospice CAP Updates.

Additional CMS website information for the Hospice Wage Index Final RuleCMS 

Delivering compassionate care in an evolving industry: OIG challengesHospice of the Valley, Phoenix, AZ; Press Release; 8/4/26... Over nearly five decades, Hospice of the Valley-West (HOV-West) has served our community and been a national leader in end-of-life care. We are committed to excellent clinical care along with being strong advocates of regulatory compliance and proponents of responsible stewardship of public resources. This commitment is shown in a number of ways: HOV was ranked among the top three hospices in the nation for high-quality care. ... An OIG third-party contractor audited 100 hospice claims for care provided during the first two years of the COVID-19 PHE. The OIG praised HOV-West for strong internal controls, policies and procedures. During the review, their third-party auditor agreed with 85 records, denying 15 records. In conversation with the OIG, they stated that this represents good results. However, HOV-West strongly disagrees with the 15 denials and we believe they will be overturned through the review and appeal process. ... The OIG report can be read here.

Hospice care in the era of AI: hospices' views on data-driven tools to support live discharge decisionsJournal of the American Geriatrics Society; by Elizabeth A. Luth, Caitlin Brennan, Susan Hurley, Kira G. Sheldon, Yongkang Zhang; 8/3/26 Live discharge occurs for 20% of hospice enrollees, resulting in loss of support and disruptive care transitions, with higher risk for patients with Alzheimer's disease and related dementias (ADRD). Little is understood about how data-driven clinical decision support tools (e.g., predictive algorithms) might support decision making regarding live discharge. ... This paper advances our understanding of multilevel factors hospices face in supporting patients discharged alive. It establishes hospices' interest in adopting data-driven tools to support live discharge and outlines criteria for successful development and implementation of these tools.