Senators Ask CMS for Briefing on Hospice Fraud

Leaders of the U.S. Senate’s Comprehensive Care Caucus have asked federal regulators to examine program integrity within the Medicare Hospice Benefit.

The four senators wrote to the U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, urging the agency to investigate a spate of newly licensed hospice operators in multiple states that some have associated with suspicious or unethical practices.

Sens. Jacky Rosen (D-Nev.), Tammy Baldwin (D-Wis.), Deb Fischer (R-Neb.) and John Barrasso (R-Wy.) penned the letter, which asked CMS to provide a briefing on the issue within two weeks.

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“Medicare fraud cannot be tolerated, especially when it is being perpetrated on our nation’s most vulnerable patients,” the senators wrote. “Therefore, we request you initiate an investigation of these allegations and a review of any additional resources or authorities that may be needed to better address the proliferation of fraudulent hospice providers.”

In some instances, multiple hospices have been operating out of the same address without a corresponding increase in the population of eligible patients, as well as some individuals holding management positions at several hospices simultaneously.

The issue first gained attention late last year in California.

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The Califonia Department of Justice (CDOJ) has reported that lax oversight in the state had created an environment that enables large-scale fraud and abuse, the organizations contend. The state’s legislature has implemented a moratorium on new hospice provider licenses as well as an extensive audit of California’s licensing and oversight processes.

Similar concerns have emerged in Texas, Nevada and Arizona, according to a letter to LaSure by hospice industry groups, LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI). 

Arizona had 239 new Medicare-certified hospices appear between 2018 and 2022, representing 52% of all providers in the state. In that time frame, Nevada saw 56 newly certified hospices, and 369 emerged in Texas.

“Based on these developments, we believe that targeted moratoria and similar actions directed toward high-risk providers could serve as a valuable means for blocking or eliminating from the hospice program those who engage in improper, unethical, and potentially illegal activities that harm patients and families and taint the reputation of the broader hospice provider community,” the organizations said in the letter.

A recent investigation of hospice fraud by the New Yorker and ProPublica also pointed to this issue.

The four senators writing to Brooks LaSure founded the Senate’s bipartisan Comprehensive Care Caucus in 2019 to focus on legislation and policy to raise awareness of and improve access to palliative care.

“We strongly support increasing access to hospice and palliative care for those in need. We know the real difference these services make for patients as they face the most serious and debilitating medical conditions,” the senators wrote. “It is critically important that high-quality services continue being widely available and accessible for our nation’s seniors and those facing serious illness or injury.”

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