By NextBestFitTighter hospice oversight
Enrollment moratoriums in high-fraud areas, audits of long stays, and ownership disclosure.
Targets fraud.
Review ledgerHow this path connects
This path
Tighter hospice oversight
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Use enrollment moratoria in high-fraud areas
- Audit long stays
- Require ownership disclosure
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Hospice growth, for-profit entry, and fraud
Enrollment moratoriums in high-fraud areas, audits of long stays, and ownership disclosure target hospice fraud and protect patients.
- Fraud and improper payments
Moratoriums in high-fraud areas, audits of long hospice stays, and ownership disclosure target hospice fraud.
What it creates or worsens
- Adds paperwork, coordination, or complexity
Hospice enrollment restrictions slow legitimate growth, and audits of long stays are costly.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Hospice growth, for-profit entry, and fraud: Inappropriate hospice enrollment can remove access to curative treatment.
- Taxpayers and public budgets
- Hospice growth, for-profit entry, and fraud: Hospice fraud concerns threaten public spending.
- Fraud and improper payments: Fraud and improper payments consume public funds and premiums.
- People with employer coverage
- Fraud and improper payments: Fraud and improper payments consume public funds and premiums.
Who loses
- Hospitals, clinics, and care organizations
- Hospice growth, for-profit entry, and fraud: Hospices benefit from long-stay patients.
- Fraudulent operators and cybercriminals
- Fraud and improper payments: Fraudulent providers receive improper health payments.
Where it has been tried
- CMS hospice special focus program: Targets poor performers.Sources: MedPAC (2025)