Mark Vantrease, a 76-year-old former truck driver living with heart failure, lung disease, and liver damage, began receiving hospice care at home in June 2025. Under Medicare coverage, he benefits from nursing visits aimed at improving quality of life during his terminal illness. Hospice care has long been regarded as a compassionate service for patients nearing the end of life, but recent concerns about fraud within the industry are raising questions about access to this care.
The Trump administration drew attention to widespread hospice fraud in California, which has contributed to increased scrutiny of the sector. In response, the Centers for Medicare & Medicaid Services (CMS) imposed a six-month national moratorium in May 2026 on new hospice provider enrollments in Medicare, alongside heightened oversight in California and several other states deemed at higher risk for fraudulent activity. CMS stresses these steps are intended to safeguard patients and taxpayers without limiting care availability.
CMS Administrator Mehmet Oz highlighted the importance of protecting against fraud and safeguarding public funds. A 2023 University of Chicago study found that hospice care saved Medicare more than $3 billion in 2019 by reducing reliance on more costly treatments. Despite these savings, concerns remain about the impact of stricter regulations on both providers and patients.
California’s Attorney General, Rob Bonta, has characterized hospice fraud as an “epidemic” and has enforced a state-level moratorium since 2021. His office has pursued criminal charges and implemented emergency regulations targeting fraudulent operators. The state has the largest number of hospice organizations in the nation, predominantly for-profit entities—a notable shift from two decades ago.
The crackdown has had ripple effects within the industry. Some legitimate providers have become more cautious in referring patients to hospice care, while patients face uncertainty over which providers can be trusted. The sector’s vulnerability stems in part from historically limited licensing and oversight, which experts say is problematic given the rising demand driven by an aging population.
Skelly Wingard, CEO of By the Bay Health, a nonprofit hospice provider in Northern California caring for approximately 750 patients, acknowledges that fraud exists but warns that sweeping measures risk undermining public trust in hospice. Wingard emphasizes that hospice can deliver some of the most compassionate care in the healthcare system when properly supported.
Vantrease’s experience illustrates the benefits of hospice: his wife was trained to manage medical devices at home, supported by nurses who provide essential ongoing care such as medication management and infection monitoring. One night, nurses promptly responded to an urgent call, offering care and reassurance—a demonstration of hospice’s vital role in end-of-life support.
In response to fraud concerns, California has introduced new emergency regulations mandating higher nurse-to-patient ratios, stricter qualifications for management personnel, enhanced office standards, and pre-screening requirements for license applicants. While these initiatives are broadly welcomed for targeting fraudulent practices, health policy experts urge careful evaluation to avoid placing undue burdens on quality providers or reducing patient access to hospice services.