Medicare fraud has shifted from hospice to residence care in sure markets, in response to testimony introduced Tuesday to the U.S. Home of Representatives Methods & Means Committee.

Sheila Clark, the president and CEO of the California Hospice & Palliative Care Affiliation (CHAPCA), testified earlier than the committee that the Facilities for Medicare & Medicaid Companies should take “aggressive motion” to cease Medicare fraud in residence well being care.

“Within the discipline of residence care [fraud] This will imply that billing is totally disconnected from scientific actuality, and that the variety of beneficiaries is circulated via networks of sham entities,” mentioned Clark. “The issue grew as protecting regulatory and oversight buildings failed at each stage. They failed on licensure, they failed on certification and accreditation, they failed on Medicare enrollment and on oversight when a beneficiary complained, and that did not result in well timed intervention.”

CHAPCA represents greater than 250 member hospice and residential well being care suppliers supporting greater than 2,000 physicians.

Los Angeles County, California, was highlighted as a hotspot for fraud. Clark testified that residence well being care funds within the county reached $1.7 billion in 2024, practically double the 2018 degree. The variety of businesses billing Medicare additionally skyrocketed, from 655 to 1,800.

“When California imposed a moratorium on new hospice licensing, the fraud didn’t cease,” Clark mentioned. “It shifted to residence well being care licensing. In 2025 alone, 310 residence well being businesses enrolled in Medicare in LA County. Let me be clear, this isn’t natural development. It’s fraud moved from one Medicare profit to a different. CMS should take aggressive motion to close down the felony fraud networks.”

Payer voices additionally testified earlier than the committee. Chris Deery, director of monetary analysis at Independence Blue Cross, mentioned the insurer is seeing the impression of fraud “firsthand,” particularly within the areas of hospice and residential care advantages.

“Fraud in these areas diverts sources from legit suppliers, will increase system-wide prices and exposes susceptible sufferers to inappropriate, pointless care,” Deery mentioned.

Earlier than the committee, Clark pointed to a sequence of coverage steps the federal authorities might take to handle hospice and residential well being care fraud:

• Strengthen front-end screening of suppliers in high-risk areas
• Make earlier and extra decisive use of present federal authorities, together with focused, regional moratoriums on supplier enrollment.
• Develop a federal course of by which invalid hospice elections could be corrected instantly, with out counting on the fraudster’s cooperation.
• Require quicker and extra accountable grievance dealing with
• Preserve information distorted by fraud out of nationwide fee insurance policies and high quality reporting
• Improve analytics to detect fraud dynamics at beneficiary degree
• Requires routine audits of hospice and residential well being care price experiences, particularly in areas uncovered to fraud

In response to the Methods and Means Committee listening to, the Nationwide Alliance for Residence Care (the Alliance) expressed assist for efforts to fight fraud, waste, and abuse within the Medicare program.

“The hurt suffered by victims of Medicare fraud can’t be overstated,” the Alliance mentioned in an announcement. “Receiving care within the house is the popular alternative of care for a lot of sufferers and households, and residential well being performs a essential position in offering expert care that improves well being outcomes and reduces hospitalizations. Guaranteeing the integrity of hospice and residential care is essential to making sure that people proceed to have entry to protected, high-quality care. We thank the Administration and bipartisan lawmakers for his or her efforts to guard residence well being care from dangerous actors looking for to use it.”

Jim Parker, editor-in-chief of Hospice Information and Palliative Care Information, contributed to this story.

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