Literature Review

CMS implements enhanced oversight for MAC MBI lookup tools Hospice News; by Jim Parker; 3/17/26 ... In response to a rise in these fraudulent activities, CMS has strengthened oversight of Medicare Administrative Contractor (MAC) MBI lookup tools. The agency now monitors MBI searches against submitted claims using National Provider Identifiers (NPIs). Access to these tools may be revoked if providers conduct a high volume of lookups without submitting corresponding claims. This move by CMS is likely an important step in combatting fraud, according to Sheila Clark, president and CEO of the California Hospice and Palliative Care Association (CHAPCA).

Report: Over 40% of hospice centers in L.A. County ‘show multiple indicators’ of fraudulent activity One America News; by Addie Davis; 3/13/26 Over 700 of the roughly 1,800 hospice agencies in Los Angeles County show multiple state identified indicators of fraud, according to an analysis by CBS News. A 2022 California state audit highlights a staggering 1,500% surge in hospice agencies since 2010. By 2019, Los Angeles County’s density of hospice centers reached six and a half times the national average relative to its elderly population — a saturation point linked to an estimated $105 million in Medicare overbilling, according to CBS News.

2025 Facts and Figures Report now available to Alliance members The National Alliance for Care at Home; Alexandria, VA and Washington, DC; Press Release; 3/3/26 The National Alliance for Care at Home (the Alliance) published the 2025 edition of Facts and Figures, an annual report on key data points related to the delivery of hospice care, including information on patient characteristics, location and level of care, Medicare hospice spending, hospice provider characteristics, and quality of care. Facts and Figures – the leading resource for hospice providers and others interested in understanding the work of the community – has been published annually for over two decades. The findings in this report reflect patients who received care in 2024, provided by hospices certified by the Centers for Medicare & Medicaid Services (CMS) and reimbursed under the Medicare Hospice Benefit. ... The full 2025 Facts and Figures report is available for Alliance members online. The Executive Summary is available to the public.  Editor's Note: Pair this national data with the The Alliance and the Research Institute for Home Care release 2025 Hospice Chartbook that we posted on 2/20/26. The RIHC Hospice Chartbook mainly provides state views with some national treands, whereas this Facts and Figures report is mainly a national view with time trends.

Our hospice system subverts the very point of hospice care The New York Times; Opinion | Guest Essay by Sandeep Jauhar; 3/2/26 When my siblings and I decided to put our father in hospice care at his home in the spring of 2021, his Alzheimer’s was near end-stage. He could barely get out of bed or dress or feed himself. Hospice care seemed to be the best way for him to end his life with dignity. ... We soon encountered a harsh reality, however. Dying at home isn’t easy, even with hospice care. ... The main problem was funding. In 2024, the average per-patient Medicare payment to hospice agencies was about $200 a day, with an annual cap of $33,500. That outlay would barely pay for a part-time aide, yet it is also needed to cover medications, medical equipment and nurse visits.

The measure isn’t wrong. The story is incomplete. McKnights Long-Term Care News; by Steven Littlehale; 2/27/26 Not long ago, I was sitting across from a nursing home leadership team as they stared at a quality measure report that didn’t make sense to them. ... So we did what more facilities should do when a QM score feels off: We stopped looking at the rating and started looking at the math. That’s where the real story surfaced. It wasn’t about poor care, but about exclusions not captured, covariates not fully coded, and pieces of the clinical picture that never made it into the structured data fields the Centers for Medicare & Medicaid Services reads. 

Apex Hospice, ex-director settle False Claims retaliation suit Bloomberg Law; by Daniel Seiden; 2/20/26 Illinois-based Apex Hospice & Palliative Care Inc. and its former medical director reached a confidential settlement of a False Claims Act suit alleging the company fired her in retaliation for calling attention to Medicare fraud, a federal district court said Friday. Janice Makela’s suit is dismissed without prejudice, Chief Judge Virginia M. Kendall of the US District Court for the Northern District of Illinois said in an order.

Medicare crackdown on hospice affiliations threatening providers Bloomberg Law; by Patric Hooper, Jordan Kearney, and Maydha Vinson; 2/18/26 A new federal enforcement trend is sending shockwaves through California’s hospice sector and beyond. Health care providers are discovering that their Medicare enrollment, and often their entire practice, can be jeopardized simply because of whom they once worked with, not because of anything they personally did. The Centers for Medicare and Medicaid Services calls it affiliation. Under federal regulations, CMS or its contractors can revoke a provider’s Medicare enrollment if the agency determines that an affiliation poses an “undue risk” of fraud, waste, or abuse. 

Vance to lead sweeping anti-fraud task force investigating California Before It's News; Press Release; 2/4/26 Vice President JD Vance is poised to chair a new White House task force aimed at rooting out potential fraud and abuse in government programs in California, according to CBS News. Andrew Ferguson, chairman of the Federal Trade Commission, is expected to serve as the task force’s vice chairman and handle day-to-day operations, CBS News reports. President Donald Trump is anticipated to issue an executive order in the coming days to formally establish the group, the news outlet said.

Congressional hearing confronts hospice, health care fraud Hospice News; by Jim Parker; 2/4/26 Regulatory reform, better data and more state-federal and other stakeholder partnerships are necessary to combat health care fraud in the United States, including among hospices. This was a key message in a recent hearing by the House Energy and Commerce Subcommittee on Oversight and Investigations. Hospice fraud has been rampant in certain states. Unscrupulous providers have enrolled patients in hospice who were not eligible or without their knowledge or consent. They have also transferred patients from one hospice to another in exchange for monetary payments, engaged in “license flipping,” and paid illegal kickbacks for referrals, among other abuses.

Hospice regulatory 2025 updates- year-end overview The National Law Review; by Benjamin J. Fenton, Nick D. Jurkowitz, Much Shelist, P.C.; 2/3/26 As 2025 comes to an end, many hospice-related regulatory changes from the start of the fiscal year are now in effect and actively shaping daily operations. Providers nationwide have spent the year changing workflows, training staff, and improving infrastructure to remain compliant. 2025 Hospice Regulatory Updates:

Protecting patients at the end of life why CON still matters - part 2 Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Paul A. Ledford and Tim Rogers;  1/30/26 In Part Two of Protecting Patients at the End of Life: Why CON Still Matters, host Chris Comeaux continues the conversation with two of the nation’s most respected hospice policy leaders—Paul A. Ledford, President & CEO of the Florida Hospice & Palliative Care Association, and Tim Rogers, President & CEO of the Association for Home & Hospice Care of North Carolina. This episode moves beyond regulatory theory and into the real-world patient and family experience—especially in states without hospice Certificate of Need (CON) laws. Drawing on decades of leadership, personal stories of loved ones in hospice, and data-informed insights, Paul and Tim explore what families actually face when hospice markets are oversaturated, fragmented, or poorly regulated.

MedPAC signals need to bolster Medicare physician payments AMA - American Medical Association; by Tanya Albert Henry; 1/27/26 Influential body backs added 0.5% Medicare pay update but backtracks on linking doctor payment to practice-cost inflation. ... The influential Medicare Payment Advisory Commission (MedPAC) voted in January to address inadequate payment for Medicare physician services under current law, once again underscoring a longstanding policy failure that is widely recognized but remains unresolved. MedPAC voted to recommend an additional 0.5% update on top of the updates specified in current law—0.25% and 0.75%—and will forward that recommendation to Congress.