Members of Congress are demanding answers from the U.S. Centers for Medicare & Medicaid Services (CMS) on continuing evidence of hospice fraud and quality issues.

Reps. Beth Van Duyne (R-Texas) and Earl Blumenaur (D-Ore.) led a coalition of 38 congressional lawmakers who in a letter asked CMS for further information on how the agency intends to address these problems.

“We must urgently address the bad actors who are abusing the hospice benefit and harming patients and families,” the legislators wrote in the letter. “Hospice is an important part of a patient’s care, but only if it is operating as intended. We are prepared to work with CMS to ensure this continues to be safe for patients, while ensuring that congressional oversight is carried out.”

Reports of unethical or illegal practices have surged, particularly among hundreds of newly certified hospices in California, Texas, Nevada and Arizona. Recent evidence indicates that more of these providers are being enrolled in Medicare despite CMS’ efforts to date on curbing fraud and abuse.

Some of these providers were establishing their business, providing substandard care to a few patients and then selling off their hospices or the license.

So far, California is the only state to take action on hospice fraud, which is leading some fraudulent providers to set up shop in other states, such as Nevada.

CMS has taken “positive steps” to combat fraud, the Congress members acknowledged in the letter. Case in point, the agency has implemented a Provisional Period of Enhanced Oversight for California, Nevada, Texas  and Arizona; finalized a “36-month rule” in hospice to prevent quick licensure sales; and completed a nationwide hospice site visit project, among other efforts, the lawmakers indicated in the letter.

“However, we are deeply concerned by new reports indicating many potentially fraudulent hospices are continuing to bill Medicare and CMS is still enrolling suspicious new providers into the program,” they wrote.

Coupled with the fraud issue are those associated with quality of care. Yesterday, the U.S. Government Accountability Office (GAO) reported that nearly 15% of surveyed hospices were cited with serious quality issues between 2020 and 2022. Most had multiple deficiencies. 

GAO also cited a years-long backlog of hospice surveys by state agencies and accreditation organizations, recommending that CMS prioritize completing overdue inspections.

The lawmakers posed about 10 questions to CMS about how they are addressing these problems. Among them was a request for results to date of the Provisional Period of Enhanced Oversight and a separate pilot project to review hospice claims following an individual’s first 90 days of care.

Congress members also asked what further actions the agency plans to take on program integrity, how CMS is working on this with state governments and how it will address the survey backlog and the agency’s use (or lack thereof) of new enforcement tools like civil monetary penalties, among other requests. 

Blumenauer and Van Duyne have been among the most persistent members of Congress when it comes to addressing hospice quality and fraud.

“Thank you, Representatives Blumenauer and Van Duyne, for your leadership in holding CMS accountable and safeguarding hospice patients and families from fraudulent activities,” said Ben Marcantonio, COO and interim CEO of the National Hospice and Palliative Care Organization, in a statement. “Preserving the integrity of the Medicare Hospice Benefit is paramount to ensure high-quality care for Americans with serious illness and end-of-life care needs.”