Literature Review

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:

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.

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.

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. 

CMS issues guidance to implement new limits on federal Medicaid and CHIP funding for certain noncitizens CMS Newsroom; Press Release; 4/8/26 CMS is preparing states for an upcoming change that will limit the ability to claim federal matching funds for Medicaid and the Children’s Health Insurance Program (CHIP) for individuals who are not U.S. citizens or U.S. nationals, or who fall into specific noncitizen categories identified in statute. New guidance issued today will ensure states understand their responsibility in implementing this statutory change beginning October 1, 2026. ... To view the State Health Official (SHO) letter, visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf.

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.