The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) is readying to unveil a new report that will unveil common billing trends among potentially fraudulent newly licensed hospices.

The report, “Trends, Patterns, and Key Comparisons Related to New Medicare Hospice Provider Enrollments May Indicate the Need for Further Oversight” is expected to publish in Fiscal Year (FY) 2026. It will examine potential red flags of fraud, waste and abuse among newly enrolled Medicare hospice providers’ claims data. OIG recently added the project to its work plan.

The report is designed to help identify program integrity issues among new hospices that fail to comply with the U.S. Centers for Medicare & Medicaid Services’ (CMS) Conditions of Participation, according to OIG.

“The data brief may help CMS evaluate the need for additional monitoring and program integrity efforts to ensure that hospices meet all the requirements,” OIG stated in a recent announcement. “Our objective is to identify trends, patterns and key comparisons that indicate potential vulnerabilities related to new Medicare hospice provider enrollments.”

This is the latest regulatory move as program integrity concerns have heated up in the hospice space, spurring a host of increased oversight and an uptick in enforcement activity in recent years.

Majority of the issues have occurred in four fraud hotbed states of Arizona, California, Nevada and Texas where swarms of newly licensed hospice operators have emerged – at rates well above national trends.

Many of these have been implicated in fraudulent activity. 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.

Other cases involve patients who were not eligible for hospice being enrolled without their knowledge or consent or billing Medicare for services that were not delivered.

“This audit aims to examine the enrollment trends of new Medicare hospice providers, focusing on potential patterns that may necessitate enhanced oversight. The findings could have significant implications for hospice providers nationwide, especially concerning compliance and enrollment practices,” Sheila Clark, president and CEO of the California Hospice and Palliative Care Association, said in a social media post.

To date, only California has ramped up oversight with integration of new laws in recent years designed to limit growth of new hospices. Additionally, Nevada lawmakers in March introduced a bill proposing a number of measures that could widen the scope of state enforcement activity.

CMS has taken greater steps to address hospice program integrity. Provisions in its 2024 home health rule included the implementation of a 36-month rule for hospice providers. The final rule forbids any change in majority ownership during the 36 months after initial Medicare enrollment, including acquisitions, stock transactions or mergers. The agency has also implemented a period of enhanced oversight for hospices in the four hotbed states.