By Robin Heffernan, Empassion CEO

A recent investigation by CBS News has brought renewed attention to hospice fraud — and to the oversight gaps that allow it to persist.

In Los Angeles County alone, hundreds of hospice providers have been flagged with warning signs of potential fraud and abuse. Federal officials, including CMS and the Department of Justice, have also pointed to billions of dollars in improper hospice billing over time.

These findings are alarming, but they are not isolated.

They reflect structural vulnerabilities in how hospice care is regulated, monitored, and evaluated across the broader Medicare hospice program.

Hospice fraud isn’t just a billing issue. It is a patient and family protection issue. And when fraud enters the system, it undermines trust in hospice care at one of the most vulnerable moments in a person’s life.

A Growing Problem in the Hospice Industry

Over the past decade, hospice has become an increasingly important part of the U.S. healthcare system. More than half of Medicare beneficiaries who die each year receive hospice services.

The vast majority of hospice clinicians deliver extraordinary care — supporting patients and families with compassion, dignity, and clinical expertise.

But the growth of the hospice industry has also attracted operators who view the system as an opportunity for financial exploitation.

Investigations and enforcement actions have highlighted recurring patterns:

• complex and opaque ownership structures
• unusually low patient volumes paired with high Medicare billing
• patients enrolled without appropriate clinical eligibility
• aggressive marketing or referral practices that prioritize revenue over care

These practices do more than waste taxpayer dollars. They erode trust across the entire hospice system — including for the providers doing the right thing.

Why Hospice Fraud Threatens the Medicare Hospice Program

The Medicare hospice benefit was designed to ensure that patients with serious illness receive care focused on comfort, dignity, and quality of life.

Fraud distorts that mission.

When bad actors enter the hospice market, they exploit gaps in oversight and referral systems. In some cases, patients are enrolled who do not meet eligibility criteria. In others, providers prioritize growth and billing over patient-centered care.

The result is a system where responsible hospice providers must compete alongside organizations that may not be operating with the same standards of clinical integrity.

Enforcement Alone Cannot Solve Hospice Fraud

Federal and state agencies have increased enforcement in recent years, including audits, investigations, and criminal prosecutions.

These efforts are necessary.

But they are also inherently retrospective. They typically occur after harm has already taken place — after patients have been misled, families have lost trust, and taxpayer dollars have been improperly spent.

The deeper structural problem is this:

The hospice system lacks a clear, standardized framework — backed by industry and recognized by regulators — to identify high-quality providers before a referral is made.

Just as importantly, the system lacks the infrastructure to monitor hospice performance in real time, detect emerging risks, and act before harm occurs.

In most communities, patients and families must make hospice decisions quickly and with limited information. Even hospitals and physician groups often lack reliable tools to evaluate provider quality.

The Need for Greater Transparency in Hospice Quality

For hospice care to maintain public trust, the healthcare system needs stronger mechanisms that promote both transparency and accountability.

Patients, families, and referring providers should be able to answer basic questions:

• Who owns this hospice organization?
• What clinical standards guide its care?
• How does it perform on key quality and utilization metrics?
• What oversight or validation frameworks are in place?

At the same time, regulators need more modern tools to monitor performance.

Oversight today remains largely retrospective. More timely reporting and continuous monitoring of key metrics could help identify anomalies earlier, reduce risk, and prevent harm.

Without infrastructure to monitor, manage, and act on data, even well-intentioned oversight efforts will fall short.

Elevating Responsible Hospice Providers

Strengthening enforcement is only part of the solution.

The healthcare system must also do a better job of identifying and elevating providers delivering high-quality hospice care with integrity.

One example of this approach is Empassion Assured, an independent certification program designed to help identify hospice providers that meet rigorous standards for clinical integrity, ethical practices, and patient-centered care.

Programs like this are not a substitute for regulation. But they can complement public oversight by providing clearer signals of quality to patients, families, payers, and providers.

Creating a more vetted, trusted, and transparent hospice ecosystem requires both stronger enforcement and better ways to recognize providers who are doing the right thing.

Moving the Conversation Forward

Investigative reporting has brought needed attention to hospice fraud and the risks it poses to patients and families.

Now the focus must shift to what comes next.

Policymakers and regulators have an opportunity to strengthen oversight, improve transparency, and modernize how hospice performance is monitored and evaluated.

As other industries have shown, effective oversight often depends on alignment between public regulation and credible, independent mechanisms that support accountability and trust.

Responsible providers — and the frameworks that help identify them — must be part of that solution.

About Robin Heffernan

Robin Heffernan is co-founder and CEO of Empassion Health and a longtime leader in hospice and palliative care. She works with health systems, payers, and policymakers to improve quality, transparency, and accountability in end-of-life care.