Hospice Scoring System for Fraud Detection and Transparency

Press Releases Apr 02, 2026

CMS Proposes New Transparency Measures to Strengthen Oversight of Hospice Providers

Administration Fraud, waste, & abuse Hospices Share

CMS Proposes New Transparency Measures to Strengthen Oversight of Hospice Providers
Hospice Scoring System Would Increase Accountability and Protect Beneficiaries

As part of its continuing efforts to combat fraud and strengthen program integrity, the Centers for Medicare & Medicaid Services (CMS) is looking to shine a light on potentially concerning hospice billing and beneficiary care delivery. In the FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Proposed Rule, CMS is unveiling a new, publicly available hospice scoring system based on indicators of potential inappropriate utilization, quality of care, and compliance concerns, holding suspicious facilities accountable while allowing legitimate hospices to thrive.

This scoring system is part of CMS’ broader efforts to strengthen oversight, increase transparency for families, and ensure Medicare hospice benefits are not abused by fraudulent actors and are providing appropriate care to beneficiaries. These efforts aim to protect beneficiaries and support high-quality providers delivering compassionate end-of-life care.

“Hospices exist to help Americans die peaceful, dignified deaths, not to line the pockets of fraudsters,” said CMS Administrator Dr. Mehmet Oz. “These new transparency measures will make it easier for CMS and others to identify hospice providers that misuse Medicare dollars, cut off their funding, and refer them to law enforcement for criminal prosecution.”

These increased transparency measures would complement CMS’ ongoing efforts to ensure program integrity within the Medicare hospice program. The agency has taken a targeted, data-driven approach to identify and address fraudulent activities at hospices, which has included unannounced hospice site visits nationwide and the revocation or deactivation of hundreds of hospice providers engaged in improper activity. Enhanced oversight in four states with elevated fraud risk—Arizona, California, Nevada, and Texas—has resulted in more than 200 hospice Medicare enrollment revocations for failure to comply with CMS requirements. CMS has since expanded this targeted oversight approach to additional states, including Georgia and Ohio.

Hospice Service and Spending Variation Index

CMS maintains that virtually all care and services needed for individuals approaching the end of life should be provided in a hospice setting except in rare and unusual instances. However, CMS has seen non-hospice spending continue to rise for terminally ill individuals in recent years. CMS’ service and spending variation index (SSVI) will assign hospices a score based on a variety of metrics CMS gathers from hospice claims including: non-hospice spending, percent of beneficiaries discharged with a length of stay of 180 days or more, average minutes per routine home care day, and percent of live discharges where beneficiaries return to the same hospice in seven days, among others. These metrics were chosen to compare spending and care delivery between hospices.

While this information is not a direct indicator of fraud, waste, or abuse, a high SSVI score would represent a potential higher level of concern, as this may signal potential program integrity risks or inappropriate utilization. This could potentially indicate further need for oversight.

Provider-level data and each facility’s SSVI score would be posted on CMS’ Hospice Center webpage. While most hospices are anticipated to have a low score, facilities with high-end scores could be subject to additional review to assess potential program integrity or compliance issues.

Care Compare Icon for Non-Compliant Hospices

To further support transparency and to help consumers make more informed choices regarding hospice care, CMS is proposing a new icon for the agency’s Medicare.gov Care Compare site to identify hospices that did not meet requirements under the Hospice Quality Reporting Program (HQRP).

CMS found that in CY 2025, the percentage of hospices that were not in compliance with HQRP reporting requirements was roughly 20%, similar to previous years. This consistent lack of data for approximately one-fifth of hospices limits CMS’ ability to accurately measure the quality of care provided by hospices and limits the amount of data available to consumers.

The potential addition of a consumer-friendly icon would aid people electing hospice and their families by indicating that CMS may not have sufficient quality data to assess a hospice’s performance. The icon would also provide an incentive for hospices to meet reporting requirements.

Mandatory Hospice Election Statement Addendum

CMS is also seeking to bolster transparency and further empower Medicare beneficiaries by proposing to require hospices to provide the hospice election statement addendum to all Medicare beneficiaries upon the election of hospice care.

The addendum explains, in plain language, which items, services, drugs, and conditions the hospice says are not related to a patient’s terminal illness and related conditions and will not be covered under the Medicare hospice benefit. Currently, hospices must provide a hospice election statement addendum only upon request by a patient (or their representative).

The proposed rule would require hospices make the Addendum available to all beneficiaries, providing them with increased transparency regarding non-covered items, services, and drugs. This is intended to reduce confusion and ensure beneficiaries clearly understand coverage decisions at the time of hospice election. The change could decrease beneficiary out-of-pocket costs and lessen the burden created by having to proactively seek out information at a very vulnerable time.

FY 2027 Hospice Routine Annual Rate Setting Changes

For FY 2027, CMS proposes to update the hospice payment rate by 2.4% (an estimated increase of $785 million in payments from FY 2026). This results from the proposed 3.2% inpatient hospital market basket percentage increase reduced by a proposed 0.8 percentage point productivity adjustment, required by law.

The proposed FY 2027 rates for hospices that do not submit the required quality data would reflect the proposed FY 2027 hospice payment update percentage of 2.4% minus four percentage points as required by law, which would result in a 1.6% reduction over the previous year’s payment rate.

These proposed payment rates reflect the most accurate, updated data available on the cost of goods, services, and labor. Hospice payments are subject to a statutory aggregate cap which limits the overall payments made to a hospice annually. The proposed hospice cap amount for FY 2027 is $36,210.11.

The proposed rule can be viewed in the Federal Register at https://www.federalregister.gov/d/2026-06604.

Review the Fact Sheet at: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2027-hospice-wage-index-payment-rate-update-hospice-quality-reporting-program.

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