By NextBestFitHospice growth, for-profit entry, and fraud
Medicare spent $25.7B on hospice in 2023 for 1.7 million people. Rapid entry of for-profit hospices has brought fraud concerns and patients enrolled who aren't dying.
Evidence
- $25.7B Medicare hospice spending, 1.7M beneficiaries, ~6,500 providers (2023).Sources: MedPAC (2025)
Who's affected
Who is hurt
- People with ongoing or specialist care needs: Inappropriate hospice enrollment can remove access to curative treatment.
- Taxpayers and public budgets: Hospice fraud concerns threaten public spending.
Who gains while it lasts
- Hospitals, clinics, and care organizations: Hospices benefit from long-stay patients.
Under your mix of paths
Paths that fix or soften it
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Root causes
- Per-diem payment rewards long stays
- Requirement to give up curative care
Related costs
Open questions
- Should patients be able to receive hospice and curative care together?
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Enrollment moratoriums in high-fraud areas, audits of long stays, and ownership disclosure.
- +Hospice growth, for-profit entry, and fraud
- +Fraud and improper payments
- −Adds paperwork, coordination, or complexity
Require non-profit hospiceRejected
Only non-profit or public organizations may provide hospice.
- +Hospice growth, for-profit entry, and fraud
- −Providers leave, retire, or go cash-only if pay drops
- −Takes years, or money up front, before it pays off