Alert 04.16.26
Media Coverage
Source: Hospice News
Media Coverage
Press Contacts: Erik Cummins, Matt Hyams, Taina Rosa, Olivia Meyer
06.12.26
Regulatory oversight of the hospice industry is intensifying in response to fraud and program integrity concerns, creating greater compliance burdens for providers and prompting closer scrutiny of areas such as referral arrangements, ownership structures and billing practices. Recent news coverage also highlights the challenges providers face in navigating subjective patient eligibility requirements, which can lead to investigations and enforcement actions even in the absence of international fraud.
In an interview with Hospice News, Corporate Investigations & White Collar Defense counsel Dylan Aste described kickback schemes as a “hallmark” of hospice fraud, often involving aggressive patient recruitment efforts tied to improper financial incentives.
The next iteration of fraud is already emerging, he said, pointing to recent enforcement actions that reveal increasingly “sophisticated and organized” schemes. These unscrupulous operators frequently leverage data to maximize referrals while minimizing the risk of regulatory detection, he added.
Historically, uneven government oversight allowed some fraudulent models to persist for extended periods. However, Aste said enforcement efforts are becoming more sophisticated, with regulators increasingly relying on data analytics, referral trends and billing pattern recognition to identify suspicious activity. He also noted that the U.S. Centers for Medicare & Medicaid Services’ (CMS) has increasingly “worked in parallel” with state agencies, the FBI, the DOJ and the U.S. Department of Health and Human Services Office of Inspector General.
Aste pointed to the DOJ’s recently established Anti-Fraud Strike Force and heightened enforcement activity in the western states, including the suspension of hundreds of hospice licenses tied to allegedly fraudulent operators, as signs of a more coordinated regulatory and enforcement approach.
Given this landscape, even reputable hospice providers should prepare for increased regulatory scrutiny and potentially more aggressive enforcement efforts in the years ahead, he said.
“Expect real-world pressure testing, such as undercover operations to see if providers will accept kickbacks or [if] entities will pay kickbacks for a referral,” he said. “Also, expect public-facing and visible enforcement actions meant to send a deterrent signal—dawn raids and search warrant executions by federal agents in blue jackets. If your data tells the wrong story, you’re already on the radar. Regulators are no longer only asking, ‘Is there a complaint?’ They are asking, ‘Does the data make sense?’”
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