Throughout the 1980s, in the early days of building hospice care into the American healthcare system, those of us on the frontlines helped shape what would become the Medicare hospice benefit. It was a turning point in how this country cares for people at the end of life.
At its core, the hospice benefit is simple. It allows patients facing serious illness to receive comfort-focused care, wherever they call home, supported by a team that addresses not just medical needs, but emotional and spiritual ones as well.
For millions of families, it has meant more dignity, more support, and more time focused on what matters most.
That’s why the scale of fraudulent hospice activity in California is so deeply concerning. This is not a gray area. It is widespread fraud, targeting vulnerable patients and exploiting gaps in oversight.
In Los Angeles County alone, hundreds of hospice providers have been flagged with indicators of fraud, pointing to a level of activity that is far more systemic than isolated incidents.
Californians receiving hospice care, and their families, should be focused on quality time and quality of life, not questioning whether the care they are receiving is legitimate. The breadth of recent enforcement actions and license revocations makes clear that this is a serious, ongoing problem that demands immediate and sustained action.
The national organization I founded, the National Partnership for Healthcare and Hospice Innovation (NPHI), represents leading nonprofit, mission-driven hospice and advanced illness care providers across the country, including many serving communities across California. From that vantage point, we believe a temporary moratorium on new hospice provider enrollments is the most immediate and effective step to stop the influx of fraudulent operators, root out those already exploiting the system, and restore trust in the Medicare hospice benefit.
We recently called on the Centers for Medicare & Medicaid Services (CMS) and its leadership, including Administrator Mehmet Oz, to act without delay. In a letter sent out in March, we urged the agency to implement a temporary nationwide moratorium in response to the continued growth of fraudulent providers — actors who target vulnerable patients, undermine public trust, and threaten the integrity of the benefit itself. This is not a recommendation we make lightly, but it is a necessary step to halt the entry of new fraudulent providers.
Any moratorium must be carefully designed — time-limited, paired with a clear exemption criterion for demonstrated need, and a plan to maintain access to existing telehealth flexibilities. A pause in new enrollments, combined with targeted oversight, would give CMS the opportunity to reset the system in a way that protects patients without disrupting access to high-quality care. At the same time, what is happening right now should not undermine confidence in hospice care or cause patients and families in California and across the country to hesitate when considering it. When delivered as intended, hospice remains one of the most compassionate and effective models of care in our healthcare system.
That is why the response must be precise. Broad, one-size-fits-all policies that burden high-quality providers will not solve this problem. Oversight should focus on providers that exhibit clear signs of risk, with better use of data to identify outliers and more consistent, targeted audits. Enforcement must be swift and decisive in removing fraudulent operators. Just as importantly, we must continue to support and elevate the providers delivering this care the right way. For decades, nonprofit hospice organizations have set the standard for compassionate, high-quality care — they are not the problem, but essential to the solution and the model for how hospice care should be delivered.
The hospice movement that emerged in the latter half of the last century improved conditions for patients in the later years of life, replacing sterile, clinical hospital settings with holistic care centered on pain management, dignity, and quality of life. As hospice care became more widely available and demand grew, the field expanded to serve more patients and families across the country. With that growth, gaps in oversight have been exploited by a small number of bad actors delivering substandard, and in many cases no, care. We cannot allow the actions of a few—whether in California or anywhere in the country—to undermine the integrity of an entire field or the trust placed in it by patients and families. Hospice is about humanity. It is about showing up when it matters most. That mission is worth protecting.
As larger shares of the Baby Boomer generation and those that follow reach advanced age, more Americans than ever will rely on hospice care. Now is the time to address gaps in the system and fix them the right way. In 2024 alone, the Medicare hospice benefit served more than 1.8 million beneficiaries, including over half of all Medicare decedents — a reflection of just how essential this care has become for families across California and the nation.
By implementing a time-limited nationwide moratorium alongside rapid, targeted reforms, CMS can focus on rooting out bad actors through targeted oversight, helping protect the integrity of the Medicare hospice benefit and ensure high-quality care for patients. Millions of Americans are counting on us to get this right.
Tom Koutsoumpas is the founder & CEO of the National Partnership for Healthcare and Hospice Innovation (NPHI)