The U.S. Centers for Medicare & Medicaid Service (CMS) is locking horns with scammers, and hospices need a transparent view into the agency’s methods.
CMS routinely monitors billing activity, beneficiary complaints and other indicators that may signal potential fraud, an agency spokesperson told Hospice News. When suspicious activity is identified, the agency can take several actions, including suspending payments, revoking Medicare billing privileges and referring cases to law enforcement.
The agency generally refers suspected fraud to the U.S. Department of Health and Human Services Office of Inspector General (OIG) and the U.S. Department of Justice (DOJ) for investigation and potential enforcement action, according to CMS.
“Healthcare fraud is real, documented and devastating — and stealing from people at the most vulnerable moment of their lives isn’t just fraud, it can cost them their future,” CMS Administrator Dr. Mehmet Oz told Hospice News in an email. “When bad actors trick patients into fraudulent care, they don’t just drain taxpayer dollars; they strip people of medical care that could help them live longer. That’s unconscionable, and CMS is going to drive these predators out of the health system.”
In recent years, CMS has implemented several other measures, including conducting unannounced site visits at Medicare-enrolled hospices, restricting the transfer of provider agreements and Medicare billing privileges for newly enrolling hospices for 36 months, and requiring the “highest level” of provider enrollment screening, an agency spokesperson said. The enhanced screening includes fingerprint-based background checks for all hospice owners with at least a 5% ownership interest.
Hospice care has historically been considered a high-risk area for Medicare fraud, prompting CMS to increase oversight in several states, the agency’s spokesperson said. Through its Provisional Period of Enhanced Oversight (PPEO) initiative, launched in July 2023, CMS began subjecting newly enrolling hospices and those undergoing changes in ownership in Arizona, California, Nevada and Texas to additional scrutiny, including medical reviews of hospice claims.
The initiative was expanded to existing Medicare-enrolled hospices in September 2024. As of Dec. 30, 2025, enhanced oversight also applied to newly enrolling and existing Medicare-enrolled hospices in Georgia and Ohio.
CMS emphasizes that placement under enhanced oversight does not constitute a finding of fraud or a determination that a provider is ineligible to participate in Medicare. Hospices that satisfy applicable enrollment and certification requirements may continue participating in the program while remaining subject to additional monitoring intended to address potential program integrity risks, the agency indicated.
According to CMS, its enhanced hospice oversight initiatives have resulted in more than 700 revocations of Medicare billing privileges involving hospices and their affiliated enrollments.
CMS implemented a six-month, nationwide moratorium on new Medicare hospice enrollments, effectively pausing the entry of additional providers into a service area the agency considers particularly vulnerable to fraud. This action was “data-driven,” according to the agency’s spokesperson.
CMS has the authority to impose enrollment moratoria for six-month periods, and it may extend them in additional six-month increments when warranted. Any decision to extend or lift the moratorium will be announced through a notice in the Federal Register, CMS said in an email.
The agency also continues to expand its use of technology and data analytics to identify and prevent fraud. The agency has long relied on advanced analytics, beneficiary complaints and referrals from providers, state agencies and law enforcement to identify suspicious billing patterns and potential fraud, waste and abuse across Medicare programs.
More recently, CMS has increased its use of artificial intelligence to accelerate fraud detection and improve its ability to identify and stop bad actors before improper payments are made.
“Use of advanced data analytics to detect fraud is nothing new for the agency. CMS routinely employs these tools, as well as other data sources such as beneficiary complaints, and referrals from providers, states, and law enforcement to identify suspicious billing patterns across its programs for potential fraud, waste, or abuse,” the CMS spokesperson told Hospice News in an email. “CMS’ increased use of Super Intelligence in these efforts has increased the speed and effectiveness with which that agency is able to detect and stop fraudulent actors before improper payments are made.”
Earlier this year, President Donald Trump in an executive order directed federal agencies to use the term “super intelligence” in place of “artificial intelligence.”
The agency has also intensified efforts to address hospice-related scams, including cases in which beneficiaries are enrolled in hospice without their knowledge or consent. CMS maintains that beneficiaries should not lose access to covered medical services as a result of an unauthorized or fraudulent hospice election, the spokesperson said.
To address the issue, CMS launched a hospice election notification pilot in Nevada last year. Under the initiative, beneficiaries receive letters confirming whether they knowingly elected hospice care, helping identify and prevent unauthorized enrollments. CMS expanded the pilot to California in December 2025.
CMS has also established a Rapid Response Team to assist beneficiaries who report fraudulent or unauthorized hospice elections. The team works to expedite the removal of improper hospice enrollments, allowing affected beneficiaries to regain full access to their Medicare benefits without interruption, according to the agency.
“CMS is dedicated to ensuring everyone served by its programs receives the care they need and is treated with dignity at all stages of life. Ensuring patient safety and access to quality care at hospice and certified care facilities is paramount to CMS’ work,” the agency spokesperson said. “Effective oversight and enforcement are important to protect the integrity of CMS programming, especially when it comes to end-of-life care.”
