Literature Review

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.”

Social work involvement in advance care planning post US 2016 Medicare policy change: A systematic reviewBMJ Supportive & Palliative Care; by Peiyuan Zhang, Yixuan Wang, Jihyeong Jeong, Kaipeng Wang, John G Cagle; 4/26Since 2016, the US Medicare programme has reimbursed physicians and advanced practice providers for advance care planning (ACP) discussions; however, social workers-who play a critical role in ACP-remain excluded from reimbursement. Across studies, clinical social workers demonstrated strong knowledge of advance directives and reported high levels of confidence in facilitating ACP discussions. Most participants expressed positive attitudes towards ACP and viewed ACP facilitation as a core professional responsibility. Intervention studies suggested that social worker-led ACP initiatives may increase patient engagement in ACP, particularly completion of formal ACP documentation. These findings support ongoing policy discussions regarding the inclusion of social workers in ACP reimbursement frameworks.

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.

Hospice fraud enforcement in America: A running record of every publicy announced federal and state criminal action against hospice fraud between April 2025 and April 2026 LundPerson and Associates; by Judi Lund Person; updated 4/15/26 The facts, data, players, and more, with ongoing updates by Judi Lund Person, hospice regulatory expert.

Who pays for hospice care in a nursing home? U.S. News & World Report; 4/23/26 ... Some people who pursue hospice care through nursing homes do so after a period of skilled nursing care, whereas others move to a nursing home in direct pursuit of hospice. However you time your transition, initiating hospice is a big decision.. To make sure you or your loved one is ready to make the change, consider the differences between how nursing homes provide hospice treatment and skilled nursing care, and how you’ll fund the transition.

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]

An open letter on stopping fraud before it starts Community Health Accreditation Partners (CHAP); by Teresa Harbour and Nathan J. DeGodt; 4/22/26 Recent testimony before the House Ways and Means Committee underscored a truth that many in healthcare have long understood. Preventing fraud requires stopping bad actors before they enter the system. We agree. At CHAP, that principle has guided our decisions for decades. Accreditation integrity is maintained at the front end of the process through disciplined, patient‑centered safeguards. ... CHAP did not accredit any hospice or home health organizations operating from the notorious Friar Street address highlighted in recent media coverage and congressional hearing. ... Before any organization advances in our accreditation process, CHAP conducts address validation and ownership verification. These steps are designed to surface red flags early, ...

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.

Fraud migrating from hospice to home health, witness warns Congress Home Health Care News; by Morgan Gonzales; 4/21/26 Medicare fraud has shifted from hospice to home health in certain markets, according to testimony presented to the U.S. House of Representatives Ways & Means Committee on Tuesday. Sheila Clark, the president and CEO of the California Hospice & Palliative Care Association (CHAPCA), testified before the committee that the Centers for Medicare & Medicaid Services must take “aggressive action” to cull home health Medicare fraud. ... CHAPCA represents more than 250 hospice and home health provider members supporting more than 2,000 clinicians.

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: