Hospice Regulatory Compliance
Medicare-certified hospice agencies and palliative care organizations.
81
Total Enforcement Actions
66
Actions This Year
—
Total Penalties Tracked
81
Critical / High Severity
Regulatory Overview
Medicare-certified hospice agencies must comply with 42 CFR Part 418 — the Hospice Conditions of Participation. The OIG has identified hospice as a high-risk area for continuous care (crisis care) billing fraud and for improper enrollment of patients who do not have a terminal prognosis. CMS conducts focused surveys on live discharge rates and election statement documentation.
Primary Enforcement Focus
OIG hospice fraud investigations target continuous care billing and non-terminal patients. CMS focused surveys examine election statement deficiencies. Live discharge rates above thresholds trigger scrutiny.
Common Violation Patterns
Non-Terminal Patient Enrollment
Billing Medicare for patients who never had a terminal diagnosis or whose life expectancy exceeded 6 months — top OIG false claim target.
Continuous Care Billing Fraud
Billing crisis-level care rates for patients receiving routine care. OIG investigations routinely find billing records inconsistent with clinical notes.
Election Statement Deficiencies
Missing, incomplete, or outdated election statements. Top finding in CMS focused hospice surveys.
Interdisciplinary Team Failures
Inadequate IDT composition, infrequent IDT meetings, or care plans not updated based on patient condition changes.
Enforcement Actions — Hospice
Violations Signal Board
Latest Hospice NewsAll
Improving Trauma-Informed End-of-Life Support for Indigenous Populations
The end of life can come with significant challenges for underserved and under-resourced patient populations, including indigenous tribal communities. Hospices seeking to improve quality and disparities need a trauma-informed care delivery approach, as well as greater cultural staffing diversity and education. Culturally inclusive recruitment and retention policies can help hospices to bridge wide gaps of […] The post Improving Trauma-Informed End-of-Life Support for Indigenous Populations appeared first on Hospice News.
Future Leader: Wendy Amerson, Director of Hospice Sales, Axxess
Wendy Amerson, Director of Hospice Sales at Axxess, has been named to the Future Leaders Awards Class of 2026 by Hospice News. To become a Future Leader, an individual is nominated by their peers. The candidate must be a high-performing employee who is 40 years of age or younger, a passionate worker who knows how […] The post Future Leader: Wendy Amerson, Director of Hospice Sales, Axxess appeared first on Hospice News.
Compassus, Providence Execs: Greater Transparency Needed on Hospice Quality
Greater transparency around hospice quality could help counter eroding trust among the public due to widespread fraud, according to executives from the home health and hospice provider Compassus and the Providence Health System. Media outlets have reported extensively in recent years about a proliferation of fraud in certain markets, particularly Arizona, California, Nevada, Texas, Georgia […] The post Compassus, Providence Execs: Greater Transparency Needed on Hospice Quality appeared first on Hospice News.
AI End-of-Life Navigation Takes Flight
Families often lack resources and knowledge to navigate a fragmented health care system, particularly at the end of life. New artificial intelligence tools are paving ways for improved family caregiving education and support. Transitioning from curative treatment to comfort care can be a jarring experience for patients and their families, according to Lorenz Valdez, founder […] The post AI End-of-Life Navigation Takes Flight appeared first on Hospice News.
Mission Healthcare Expands in Oregon, California
Mission Healthcare has cut the ribbon on three de novo locations in Oregon and California. The three new operations are located in Bakersfield, California; Salem, Oregon and Portland, Oregon. All three opened within the past week, expanding the company’s footprint in the western United States. “There’s a massive difference between opening a new office on […] The post Mission Healthcare Expands in Oregon, California appeared first on Hospice News.
Key Regulations
42 CFR Part 418 — Hospice CoPs
Conditions of Participation covering election statement, plan of care, interdisciplinary team, and levels of care documentation.
Hospice Election Statement (418.24)
Patient must elect hospice, waiving curative treatment. Documentation deficiencies are a top survey citation.
Continuous Home Care / Crisis Care
Medicare pays crisis care rate when patient has acute symptoms requiring continuous nursing. Top OIG fraud target.
HIPAA 45 CFR Parts 160 & 164
Hospice patient records are fully protected PHI. Additional sensitivity for end-of-life advance directive documentation.
OIG Hospice Compliance Guidance
OIG has published compliance program guidance specifically for hospice — voluntary but widely used as a safe harbor framework.