The U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz has issued a public announcement warning against the most common tactics being employed by fraudulent hospice operators. Program integrity concerns heating up in the hospice space in recent years have regulators increasingly seeking avenues to safeguard patients and their families against unscrupulous […]
The proposed California budget would require prior authorizations for hospice care within the state’s Medicaid program. Currently, Medicaid managed care plans who provide coverage through the state’s Medicaid system, Medi-Cal, may not perform prior authorizations for hospice. California’s Department of Health Care Services (DHCS) indicated in a 2025-2026 budget revision that this could save $25 […]
After years of nonpayment, the California Department of Health Care Services (DHCS) has instructed Medicaid managed care plans to pay hospices for nursing home room and board. The issue pertains to patients who are dually eligible for Medicare and Medicaid. When caring for patients in nursing homes, hospices typically pay for their room and board […]
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 […]
Among the numerous tactics that unscrupulous hospices use to commit fraud, three are rising to the forefront. Four states have garnered national attention as fraud hotbeds — Arizona, California, Nevada and Texas. These regions have seen swarms of new hospices emerging and receiving Medicare dollars. Numerous reports of unethical or illegal practices have surfaced, particularly […]
Stymied Medicaid reimbursement for nursing home room and board could threaten access to care for hospice patients in California and possibly other states. The issue centers around patients in nursing homes who are dually eligible for Medicare and Medicaid. When caring for patients in nursing homes, hospices typically pay for their room and board with […]
Hospices have grown increasingly frustrated by fraudulent operators in the space and how their activities affect legitimate operators’ financial health. This is the second of a two-part Hospice News series that explores how fraud, waste and abuse in the hospice space could create headwinds for the industry at large. Fraudsters misspend millions of Medicare dollars […]
“Shady” brokers allegedly continue to facilitate “license flipping” among fraudulent hospices, though new regulations have started bearing down on the practice. Some hospice owners have been selling their licenses soon after obtaining them, or before regulators can act on alleged malfeasance, according to several industry sources who spoke with Hospice News. The practice appears to […]
Fraudulent operators’ marketing strategies are morphing the competitive landscape, making it difficult for legitimate hospice providers to maintain visibility among patients and families. A mounting concern is that fraudsters stepping into the hospice industry have been implementing marketing and outreach practices that at times mirror strategies utilized by quality providers, according to Jeanne Chirico, president […]
Fraudulent activity in the hospice space may be leaving some families without sufficient bereavement support. Fraudulent hospice schemes can take a tremendous toll on families that have lost loved ones who received poor or negligent end-of-life care, according to Cheryl Kraus, director of government affairs and policy at the Hospice & Palliative Care Association of […]
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