CMS Intensifies Anti-Fraud Efforts in Hospice Sector

The Centers for Medicare & Medicaid Services (CMS) is ramping up efforts to combat fraud within the hospice sector, focusing particularly on California and Texas. Recently, CMS suspended Medicare payments to several hospice agencies in Los Angeles County due to fraudulent practices. Dr. Mehmet Oz, CMS Administrator, has indicated that fraud detection initiatives may shift to Texas, where fraudulent activities could rise in response to rigorous enforcement elsewhere.

During an April 28, 2026 speech at the National Press Club, Dr. Oz highlighted the geographic migration of fraudulent hospice operations due to intensified regulatory scrutiny. This aligns with discussions in the Texas Senate Committee on Health and Human Services about hospice providers exhibiting high live discharge rates. CMS plans to implement strategies in Texas like Medicare payment suspensions following credible fraud allegations, validated through data analytics for swift intervention.

Additional measures include Provisional Periods of Enhanced Oversight (PPEO) for newly formed hospices or those undergoing ownership changes. Targeted audits have already led to the revocation of billing privileges in several states, raising concerns about the timeliness and fairness of CMS's review process. Staffing constraints within the CMS Center for Program Integrity may be contributing to delays, affecting operational stability for compliant hospices.

Collaboration between the hospice industry and CMS aims to eradicate fraud while safeguarding legitimate providers. As these anti-fraud efforts intensify, Texas could become a critical showcase for program integrity practices, urging hospice providers nationwide to align with compliance requirements. Proactively addressing data analytics concerns will be essential for maintaining trust and continuity in the Medicare program.