Literature Review

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. 

Accreditation: moving forward during the moratorium HME News - Business News for Home Medical Equipment Providers; by Sandra Canally; 4/13/26 ... Hospice contracts: Hospice providers are required to contract only with accredited DMEPOS suppliers to equip terminally ill patients whether at the hospice facility, in a nursing home or at home. The supply opportunities closely mirror those in skilled nursing, with enteral nutrition, mobility aids and respiratory equipment all in demand. Hospice covers 100% of DME costs related to the terminal illness. [To DME companies:] Invoice the hospice organization directly, and they pay you. Medicare stays out of the transaction entirely.

Oregon governor signs Hospice Licensure Bill (SB 1575)  LegiScan - Bringing People to the Process; by Oregon Senate Bill 1575; 4/7/26New law bars individuals excluded from Medicare/Medicaid or found liable for fraud from holding ownership interest in a hospice program. 

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. 

CMS ups hospice oversight: 5 things to know Becker's Hospital Review; by Mariah Taylor; 4/3/26 CMS is implementing new oversight measures for hospice programs, which include an updated scoring system, state-specific oversight and changes to election statement addenda. The new scoring system is part of an effort to “strengthen oversight, improve transparency for patient families and ensure Medicare hospice benefits are not abused,” according to an April 2 agency news release. Here’s what to know:

8 arrested in health care fraud takedown, including owners of hospices that billed taxpayers millions of dollars to serve the ‘dying’United States Attorney's Office - Central District of California, Los Angeles, CA; Press Release; 4/2/26More Than $50 Million in Intended Health Care Fraud Losses Charged In coordination with the Vice President’s Task Force to Eliminate Fraud, eight defendants, including three nurses, a chiropractor, and a purported psychologist, have been arrested on federal charges that they schemed to defraud the nation’s health care system out of more than $50 million – including by running sham hospice care facilities that bilked Medicare by using people without terminal illnesses as beneficiaries, the Justice Department announced today.Editor's Note: As coverage escalates—often with sensational framing—we are anchoring in the official U.S. Attorney’s press release. The allegations are serious and demand accountability, but do not reflect the broader hospice field. This is a moment for leaders to reinforce clear, disciplined narratives that distinguish fraud from the mission-driven care centered on dignity and what matters most.

Hospice groups: 2.4% proposed pay raise threatens care delivery Hospice News; by Jim Parker; 4/3/26 Two of the nation’s largest hospice trade organizations decried a proposed 2.4% hospice base rate increase as inadequate in today’s financial climate. The U.S. Centers for Medicare & Medicaid Services (CMS) on Thursday issued its proposed payment rule for hospices in 2027 containing a 2.4% payment increase. If finalized, this would result in a $785 million payment boost from Fiscal Year 2026. The amount of the proposed pay raise puts the sustainability of hospice care in jeopardy, according to Linda Couch, senior vice president for policy at LeadingAge.

New CMS delivery models enable senior living providers to get paid for what they’re already doing McKnights Senior Living, Nashville, TN; by Kimberly Bonvissuto; 4/1/26 Speakers at the 2026 National Investment Center for Seniors Housing & Care Spring Conference on Tuesday shared several new federal programs that offer senior living providers opportunities to showcase their value and to get paid for what they are already doing in chronic disease prevention and management. 

Pikes Peak Hospice & Palliative Care achieves highest quality score in organization’s history Pikes Peak Hospice & Palliative Care, Colorado Springs, CO; Press Release; 3/27/26 Pikes Peak Hospice & Palliative Care has earned its highest quality ranking ever — a score of 94 out of 100 — on the National Hospice Locator, a nationwide directory that evaluates hospice providers using publicly available quality data. The National Hospice Locator compiles information from Medicare data files, public websites, and direct surveys of hospice providers. Using multiple weighted quality metrics, the platform evaluates thousands of hospice programs across the United States and allows users to compare providers based on quality rankings. With a national average score of approximately 67, a score of 94 places Pikes Peak Hospice & Palliative Care well above the national benchmark and among the highest-rated hospice organizations in Colorado.Editor's Note: What are your organization's publicly reported quality scores? Explore more at the National Hospice Locator. [Disclosure, NHL sponsors this newsletter.]

The demoralization of America's doctors Straight Arrow News; by Jess Craig; 3/30/26 Key takeaways:

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]

Medicare plan switching and hospice care among decedents with advanced cancer JAMA Network Open; by Xin Hu, Changchuan Jiang, Youngmin Kwon, Fangli Geng, Qinjin Fan, Kewei Sylvia Shi, Zhiyuan Zheng, Jingxuan Zhao, Joan L Warren, K Robin Yabroff, Xuesong Han; 3/2/16Importance: Hospice ... is an excluded benefit under Medicare Advantage (MA), with coverage instead provided by traditional Medicare (TM). With growing MA penetration, more beneficiaries also switch between MA and TM for financial protection and physician access considerations, although less is known about how different Medicare programs and plan switching behaviors affect EOL care for patients with advanced cancers.Conclusions and relevance: In this cohort study of Medicare decedents with advanced cancers, continuous MA enrollees were most likely to receive hospice at home, while those who switched from MA to TM more frequently received hospice care in nursing homes. Plan switching near the EOL may reflect access barriers, highlighting the importance of addressing care coordination to improve EOL care.