Literature Review

CMS trains its program integrity sights on Texas Hospices JD Supra; by B. Scott McBride and Howard Young; 5/5/26 California has seen hundreds of hospice “takedowns” and Medicare payment suspensions targeting what the Centers for Medicare & Medicaid Services (CMS) proclaims are a multitude of fraudulent hospices, particularly in LA County. Now, based on recent public statements of CMS Administrator Dr. Mehmet Oz, it appears CMS is poised to train its sights on fraud, waste, and abuse among Texas hospice agencies.

Hospice of Wichita Falls partners to protect against hospice fraud KFDX/KJTL News, TexomasHomePage.com, Wichita Falls, TX; by Angel Owens; 5/1/26 As concerns over hospice fraud continue to grow across Texas and the nation, Hospice of Wichita Falls is taking a strong and public stance against unethical practices that threaten patients and undermine trust in end-of-life care. The nonprofit organization is reaffirming its commitment to compassionate, ethical hospice services while partnering with state and national organizations to strengthen accountability across the industry. For over four decades, the organization has served the Wichita Falls community as a nonprofit, community-based provider dedicated to supporting patients and families through one of life’s most vulnerable and sacred seasons.

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.”

2026 Fashion Fling raises funds for Hospice Brazos Valley [and speech about fraud] The Fayette County Record, La Grange, TX; by News Staff; 4/20/26 Hospice Brazos Valley presented “Fashion Fling 2026” at a new location this year – the KC Hall in La Grange – on Saturday, April 18. About 275 ladies (along with a few gentlemen) attended the event. ... During the event, Hospice Brazos Valley CEO Lisa Mc-Nair delivered a speech: ... "“I had the opportunity last week to testify in front of the Texas Senate Health and Human Services Committee, charged with protecting taxpayer funds by preventing fraud and abuse. ... There are 1,366 hospices currently operating in Texas, which is a 98.5% increase since Jan 1, 2020. These new hospices are not rolling into to town to provide excellent hospice care; they are opening up to find ways to fraudulently bill Medicare for services. ... I am proud to tell you that ... we are one of only 24 hospices in the entire state of Texas out of the 1,366 licensed hospices, with a 5-star rating. We are in the top 1.7% of all Texas Hospices and in the top 2% in the entire nation."

Opinion: Restoring trust in hospice begins with ending Medicare fraud The Hill, Washington, DC; Opinion Contributor, Jennifer Sheets, CEO of the National Alliance for Care at Home; 4/28/26 ... While losing someone you love is excruciating, many families — including my own — feel a sense of relief by the comfort and improved quality of life that hospice offers. As a mother, nurse, and full-time caregiver for my own mom during her end-of-life journey, I am forever grateful for the providers who supported our family during our most difficult moments. So, when I hear instances of malicious hospice fraud, I am outraged — not just for the taxpayer who becomes the victim of waste, but ultimately for the individuals who could be deprived of this important care option because of the harmful actions of others. ... A recent study revealed that, understandably, older adults consider trustworthiness as extremely or very important when choosing a provider. It’s not lost on hospice professionals that trust is essential to our relationships with patients. We must give them every reason to believe in us — and most providers do by delivering compliant, patient-centered, and clinically appropriate care to patients with complex needs. 

Seven key moments: hearing on Medicare fraud United States House Committee on Ways & Means, Chairman Jason Smith, Washington, DC; Press Release; 4/27/26 [This is the official post from Rep. Jason Smith, Chairman  of the U.S. House Committee on Ways & Means.] Medicare fraud is a massive problem that costs taxpayers $60 billion every year and denies Americans access to their Medicare beneficiaries.

Tom Koutsoumpas: California’s hospice fraud crisis demands action Redlands Daily Facts | Commentary; by Tom Koutsoumpas; 4/23/26 Throughout the 1980s, in the early days of building hospice care into the American healthcare system, those of us on the frontlines helped shape what would become the Medicare hospice benefit. It was a turning point in how this country cares for people at the end of life. At its core, the hospice benefit is simple. ... For millions of families, it has meant more dignity, more support, and more time focused on what matters most. That’s why the scale of fraudulent hospice activity in California is so deeply concerning. This is not a gray area. It is widespread fraud, targeting vulnerable patients and exploiting gaps in oversight.

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]

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.

How a pickleball injury highlights fraud in California's hospice industry ArcaMax; by Richard Winton; 4/21/26 Lynn Ianni didn't learn she was apparently dying in a Los Angeles County hospice care facility until her Medicare claim for a pickleball injury was rejected. "At first we laughed because it was an obvious clerical error," the Seattle-based psychotherapist recalled before a congressional committee Tuesday, where she was providing testimony about her months-long experience in 2024 with fraud in the hospice industry. "It wasn't just frustrating, it was terrifying." Ianni appeared before the House Ways and Means Committee on Capitol Hill at a hearing that revealed details about fake claims and stolen doctors' identities. She was a victim of California hospice scammers. 

Full committee hearing on protecting patients and taxpayers: cracking down on Medicare fraud United State House Committee on Ways & Means, Chairman Jason Smith; 4/21/26 The House Committee on Ways and Means Chairman Jason Smith (MO-08) held a hearing today [4/21] examining the prevalence of fraud, waste, and abuse in Medicare and efforts to combat fraud to protect patients and taxpayers.Full Committee Hearing: April 21, 2026, 10:00AM ET

“This is the beginning”: DOJ signals intensifying health care fraud enforcement in California Pillsbury; by Christopher Lee, Dylan M. Aste, Fank Kalinski; 4/16/26 Recent U.S. Department of Justice (DOJ) and California Attorney General enforcement activity sends a clear signal that California health care entities that interact with government programs—in particular the hospice and home health industries—are now under intense scrutiny. Companies in these sectors should prepare for subpoenas, Civil Investigative Demands, and searches as a result of federal and state agencies conducting independent and parallel investigations. This uptick in government enforcement is sure to spur qui tam relators and whistleblowers. Unprepared California hospice and home health companies may face significant civil, and even criminal, exposure.

St. Croix Hospice CCO: transparency, compliance fosters growthHospice News; by Jim Parker; 4/15/26Tami Johnson-White is the newly appointed chief compliance officer for St. Croix Hospice. Johnson-White brings 30 years of health care leadership experience to St. Croix Hospice. St. Croix Hospice operates more than 85 locations across Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin. Hospice News sat down with Johnson-White to talk about her priorities as she comes into her new role, the top compliance issues facing hospices today and how they can prepare for audits.