IN-HOME CARE
Let's Stop Hospice Fraud Together
Providers & advocates should support efforts to shore up the system they’ve built
By Tom Koutsoumpas
As a leader in the creation of the modern-day hospice system, I have spent my career helping build and strengthen hospice care in the United States. Working alongside a small group of advocates, policymakers and providers in the 1980s, we helped shape what would ultimately become the Medicare hospice benefit and one of the most significant advances in end-of-life care.
Today, hospice fraud is drawing national attention. It should. What is happening in parts of the country is unacceptable.
Federal authorities have arrested multiple doctors, nurses and fraudulent hospice operators accused of running large-scale schemes that enrolled people who were not terminally ill into hospice and billed Medicare for hundreds of millions in false claims. This outrageous behavior is the result of bad actors who have found ways to exploit gaps in oversight and are taking advantage of some of the most vulnerable people in our health care system. This deliberate attempt to defraud and abuse the Medicare hospice benefit that I, and so many others, worked hard throughout the 1980s to deliver is a direct harm to patients, families and the integrity of an entire hospice program that millions of Americans rely on.
But it is not a failure of the hospice model.
The Value of Hospice
Hospice, when delivered the right way, represents some of the highest-value care in health care today. It brings together interdisciplinary teams to support patients and families during one of life’s most difficult moments. It focuses on comfort, dignity and quality of life. It ensures people are cared for with compassion and respect. That is what hospice is meant to be. And that is what most providers deliver every single day.
Nonprofit, community-based hospice organizations in particular have long served as the backbone of care in this country. They are accountable to their communities. They are mission driven. Many of them helped build the very benefit we are now working to protect.
At the same time, there are providers who are exploiting the system in ways that cannot be ignored. In some markets, we are seeing patterns that point to organized and sustained abuse. Patients who are enrolled without appropriate eligibility. Services that are promised but not delivered. Care that exists on paper but not in reality. These practices put patients at risk and erode trust across the entire field.
This is a betrayal of the very purpose of hospice care.
Finding a Solution
The encouraging news is that this challenge is solvable — and we’re already seeing meaningful momentum with proposed solutions. At the National Partnership for Healthcare and Hospice Innovation, we have been working closely with federal leaders and the administration to help shape solutions that are both effective and responsible.
Leadership at the Centers for Medicare and Medicaid Services (CMS) has taken important steps to confront these issues, and there is increased focus on program integrity and a commitment to targeted enforcement.
We recently publicly called on CMS, including Administrator Mehmet Oz, to implement an immediate, temporary, nationwide moratorium on new hospice provider enrollments. As we stated in our letter to the agency, we urge CMS to “implement a temporary, nationwide moratorium on new hospice provider enrollments in response to the continued growth of fraudulent providers in the hospice community. These bad actors exploit vulnerable patients, undermine trust and threaten the integrity of the Medicare hospice benefit.”
We do not make this recommendation lightly.
We believe it is the most immediate and effective way to stop the flow of new fraudulent operators while allowing regulators to focus on identifying and removing those already in the system.
Any moratorium should be time-limited and paired with a clear path forward. It must also preserve essential flexibilities, such as the use of telehealth for required recertification visits, which remain critical for access.
A pause in new enrollments, combined with targeted oversight, would allow CMS to reset the system in a way that protects patients without disrupting access to high-quality care.
It is also important to be clear about what this moment is not. It is not a reason to lose confidence in hospice or to hesitate when recommending it to patients.
But that is not a justification for imposing broad, burdensome policies on providers who are delivering care the right—and legally acceptable—way.
This moment is instead an opportunity to sharpen our focus.
Oversight must be directed toward providers that show clear signs of risk. Data should be used more effectively to identify outliers. Audits should be smarter and more consistent, and bad actors must be removed from the system without delay.
At the same time, we must continue to support and elevate the providers who are delivering high-quality care every day. For decades, nonprofit hospice organizations have set the standard for what this care should look like. They are not the problem. In fact, they are essential to the solution.
The Mission of Hospice
We cannot allow the actions of a few to undermine the integrity of an entire field or the trust placed in it by patients and families. Hospice is about humanity and about showing up when it matters most.
That mission is worth protecting, and I will continue to fight for it—just as I did when we built today’s system, a program that in 2024 alone served more than 1.8 million Medicare beneficiaries, including over half of all Medicare decedents.
As our population ages and more Americans than ever will need the compassionate, patient-centered end-of-life care that hospice provides, now is the time to address gaps in the system and fix them in a comprehensive way that gets it right. Millions of patients and families across America are once again counting on us to deliver by ensuring hospice care remains accessible, accountable, and worthy of the dignity it is meant to provide.
Tom Koutsoumpas is founder and CEO of the National Partnership for Healthcare and Hospice Innovation, a national membership organization advancing high-quality care for people with serious illness. A longtime healthcare policy leader, he has helped shape Medicare and hospice innovation and has been widely recognized for his national leadership in the field. Visit nphihealth.org.
Peter -adobestock.com
