Experts: Hospice fraud crisis could hurt patients
Mark Vantrease regularly sees his Vietnam War buddies over breakfast, attends his grandchildren's Little League games, and, when he's up to it, tends to his lush front-yard garden, which is dotted with shells retrieved from his abalone-diving days.
Time is precious for him. Last year, doctors told the 76-year-old former truck driver that a combination of heart failure, lung disease, and liver damage left him with only six months to live. "That was about 11 months ago," Vantrease said in a May interview, smiling at having, for the moment, cheated death.
In June 2025, Vantrease began hospice, which focuses on quality of life for terminally ill patients, receiving regular visits from a nurse at his home in Novato, California. Medicare is covering those services for him. His hospice caregivers reminded him of the attention his unit received from medical staff in Vietnam.
"We used to call them guardian angels," he said, "because they took such great care of you."
But the Trump administration's allegations of unchecked hospice fraud in California have tainted the industry's reputation, prompting concerns that fewer patients will seek the care they need. Health policy researchers and hospice administrators worry that the negative attention on the industry and potential for overly punitive regulations could put California patients and taxpayers on the losing end.
"The fraud situation has done a lot of damage to the reputation of hospices overall and undone a lot of the progress that had been made in destigmatizing hospice," said Lauren Hunt, an associate professor at the University of California-San Francisco's Philip R. Lee Institute for Health Policy Studies who focuses on hospice care. "Policymakers should pursue targeted strategies that root out fraud and abuse without overburdening the many providers who are doing the right thing."
Hospice care is facing sweeping restrictions. The Centers for Medicare & Medicaid Services in May announced a six-month national moratorium on hospice provider enrollment in Medicare and increased oversight in California and several other states with "elevated fraud risk": Arizona, Georgia, Nevada, Ohio, and Texas.
In a statement, CMS spokesperson Timothy Foster said state inaction on hospice programs rife with fraud drove the need for federal intervention. Foster said CMS believes the crackdown won't affect patients' ability to obtain services, with roughly 7,000 hospices still approved nationwide, and that it will help ensure the hospices that remain provide the care "individuals near end of life deserve."
"Ensuring patient safety and access to quality hospices and other certified healthcare services is paramount to CMS' work," Foster said.
Mehmet Oz, the CMS administrator, said the strict approach also protects taxpayer money. Studies have concluded that even as for-profit hospices have expanded, the industry has saved Medicare money by off setting other expensive care. A 2023 University of Chicago report commissioned by industry associations estimated that Medicare patients who used hospice over hospitals in 2019 saved taxpayers over $3 billion.
California has already been cracking down on the problems, with Democratic Attorney General Rob Bonta deeming hospice fraud an "epidemic" last year and asserting that the state is "on it." The state has had its own moratorium on hospice licenses since 2021, charged numerous providers with crimes over the years, and implemented emergency regulations in June to curb fraud.
Hospice administrators in good standing have already found themselves in the crosshairs: A Washington Post investigation in June found that the federal government's new antifraud task force suspended licenses for 43 legitimate hospices.
Still, Hunt and other policy researchers welcome eff orts to target unscrupulous operators.
"While most hospices are committed to providing high-quality care, there are serious concerns about a subset that exploit patients and the system for financial gain," she said.
