Washington, D.C. — A growing rift among hospice providers over whether the federal government should temporarily ban new hospice enrollments is raising questions about what the fallout could mean for nursing home residents who depend on end-of-life care.
The National Partnership for Healthcare and Hospice Innovation has formally asked the Centers for Medicare and Medicaid Services to impose a temporary nationwide moratorium on new hospice provider enrollments. The goal: give regulators breathing room to root out the wave of fraudulent operators that’s been draining billions from Medicare and Medicaid.
But not everyone in the industry agrees that a blanket freeze is the right call.
A divided industry
Tim Rogers, president and CEO of the Association of Home and Hospice Care of North Carolina and South Carolina Home Care and Hospice Association, and Paul Ledford, who leads the Florida Hospice and Palliative Care Association, pushed back in a joint letter to CMS Administrator Mehmet Oz. They called a nationwide moratorium “overkill.”
“Applying a blanket moratorium across the entire country would punish communities that have not experienced the same explosive, fraud-driven growth as southern California and a handful of other hot spots,” they wrote.
In North Carolina, there’s a demonstrated need for three new hospice programs. In Florida, at least 20 additional hospices are in the licensing pipeline to keep pace with the state’s aging population. A freeze would stall all of it.
Rogers and Ledford also warned that a moratorium could jeopardize telehealth flexibilities that hospice providers rely on for recertification — a concern that hits especially hard in rural areas where provider shortages already make in-person visits difficult.
On the other side, NPHI founder and CEO Tom Koutsoumpas argued the moratorium should be time-limited and paired with a clear enforcement plan. “This is not a failure of the hospice model of care,” he said. “It’s the result of a subset of providers exploiting the healthcare system, and that must stop.”
Why nursing homes are watching
The debate isn’t just an internal hospice fight. Fraudulent hospice operators have been caught enrolling nursing home residents in hospice programs without their knowledge — cutting off access to curative treatments and medications in the process. When a resident gets enrolled in hospice, Medicare stops covering treatments aimed at curing their condition. For someone who isn’t actually dying, that’s a dangerous trade.
California has been ground zero. Los Angeles County alone has more than 1,580 licensed hospices — over half the state’s total. Federal and state investigators have suspended or shuttered hundreds of providers in recent months, and the California Department of Justice just announced charges tied to a $267 million Medi-Cal fraud scheme involving stolen identities and sham hospice companies.
CMS Administrator Oz visited the Van Nuys area of the San Fernando Valley earlier this year, pointing out a stretch of road with 42 registered hospices in the immediate vicinity. Federal prosecutors have since arrested multiple individuals in connection with a separate $50 million Medicare fraud operation.
What comes next
Whether CMS moves forward with a moratorium — national, regional, or not at all — remains to be seen. The agency hasn’t made any public commitment. But the pressure is building from both sides, and nursing home operators who rely on legitimate hospice partners for end-of-life care are watching closely.
If a moratorium does take effect, it could temporarily limit new hospice options in states that genuinely need them. If it doesn’t, the fraud pipeline stays open.
Either way, nursing homes are caught in the middle.
