Hospice Organizations Call for Change as Lawmakers Eye Program Integrity

Members of Congress are seeking answers from federal regulators on hospice program integrity as industry advocacy groups call for further action.

Reps. Beth Van Duyne (R-Texas) and Earl Blumenauer (D-Ore.) led a group of lawmakers who wrote to Chiquita Brooks-LaSure, administrator of the U.S Centers for Medicare & Medicaid Services (CMS), asking for the agency to brief them on fraud and abuse within the hospice benefit.

“Hospice can be an important part of a patient’s care, but only if it is operating as intended,” the legislators wrote in the letter. “We stand ready to work with CMS to ensure that this continues to be a safe option for patients while ensuring that congressional oversight is carried out, and we look forward to hearing from you on these matters.”


Also today, four national hospice organizations met with LaSure to share their own concerns and recommend potential solutions — 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).

Among the key issues is a rash of newly licensed hospice operators in multiple states that some have associated with suspicious or unethical practices. The issue first gained attention late last year in California, but stakeholders have also raised concerns about providers in Nevada, Arizona and Texas.

“Our goal in collaborating with members of Congress and CMS is to ensure quality of care through improved hospice program integrity,” NHPCO COO and interim CEO Ben Marcantonio said in a statement. “The series of recommendations that [the four groups] have put forth to Administrator Brooks-LaSure, in conjunction with other national hospice groups and organizations across the country, clearly communicates our commitment to preventing fraud and abuse.”


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

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.

Thus far, California is the only state to take action on the issue, beginning with a moratorium on new hospice licenses and an extensive audit of California’s oversight processes.

On the federal level, NAHC, NHPCO, LeadingAge and NPHI have made 34 recommendations to CMS and congressional stakeholders for potential legislative and regulatory changes to strengthen oversight.

“Hospice reform must prioritize high-quality care, including the right services in the right quantity, and eliminate the opportunity for bad actors to profit off older adults and their families,” Katie Smith Sloan, President and CEO of LeadingAge, told Hospice News. “By collaborating with other hospice provider groups, Congress, and CMS, we hope there is meaningful change.”

Collectively, the organizations voiced “strong” support for a targeted, temporary moratorium on new Medicare-certified hospices in counties with “troubling trends” in the emergence of newly licensed providers.

They also called on CMS to develop red-flag criteria in the Medicare certification application process that would trigger additional scrutiny by the accrediting bodies or state surveyors before approval, as well as other changes to the Medicare Hospice Conditions of Participation.

Today’s meeting with LaSure is the most recent development in what is likely to be a lengthy period of assessing the extent of the problem and developing potential solutions.

“On behalf of our members, we look forward to working with our national partners and lawmakers to advance meaningful changes that ensure Medicare beneficiaries, and their families receive the highest quality end-of-life care that they rightly deserve,” said NPHI CEO Tom Koutsoumpas in a statement.

While CMS has yet to announce specific actions in regard to these new hospices, wheels are likely in motion behind the scenes to address the issue, NAHC President William Dombi told Hospice News.

“We were very encouraged by the strong interest in this issue expressed by Administrator Brooks-LaSure, and the clear indication that CMS is already taking action to address some areas of concern in a targeted and meaningful way,” Dombi said. “We look forward to continued work with our colleagues at the national hospice associations and with policymakers to protect the integrity of the hospice benefit and preserve access to vital hospice services for vulnerable patients and their loved ones.”

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