Executive Commentary │ Addressing Fraud in Hospice Care

Posted: May 13, 2026

A message from our President & CEO

Hospice care is at an inflection point. For families making deeply personal decisions, confidence in the system is essential. More patients and families are choosing hospice as a compassionate, patient-centered approach to end-of-life care. At the same time, increased scrutiny and recent headlines are raising significant concerns. This has driven today’s announcement from CMS of a six-month moratorium on new hospice and home health agencies. 

The reality is that growth in hospice utilization has, in some cases, been accompanied by the emergence of bad actors seeking to exploit gaps in oversight. California, where a surge in licensure applications for hospice and home health led to a state moratorium now in its fifth year, offers the clearest example. Even with limits in place, loopholes persist.

Understanding the role and limits of accreditation

As a CMS-approved accrediting organization, ACHC plays a defined and important role, but it is critical to understand both the scope and the limits of accreditation.

Accreditation is designed to assess compliance with clinical and operational standards, as defined by the state or federal regulatory bodies, including Medicare Conditions of Participation. Most fraud in this sector is financially motivated, and detecting it often requires tools and authorities that reside with state and federal regulators—not accrediting bodies.

That said, accreditation is not passive oversight. It is an active process, and when applied rigorously, it can surface concerning patterns, identify risks, and trigger action to protect patients. When concerns arise, we investigate.

In California, ACHC has worked closely with the Department of Public Health and federal partners, communicating concerns and offering recommendations to support state licensure and federal certification processes.

When oversight reveals gaps

In late 2022, ACHC’s regular process of internal audit identified irregularities in a group of new hospice agencies in California. ACHC took a closer look, ultimately invalidating these accreditations. This prompted additional investigation into other new agencies and triggered additional site visits.

To date this year, ACHC has conducted more than 150 focused surveys to validate compliance with hospice accreditation standards. These have resulted in multiple terminations, requirements for plans of correction, and additional follow-up surveys.

All survey findings are reported to the state and federal authorities.

California hospices are in the news because of recent indictments, but the state is simply an example of the broad, ongoing effort to ensure quality services for patients nationwide. Accreditors like ACHC are leaders in this effort.

Closing loopholes, protecting patients

Strengthening accountability requires coordination across accrediting bodies, regulatory agencies, and lawmakers. No single entity can close these gaps alone. ACHC’s survey process is designed to detect operational and quality-related red flags via rigorous, on-site surveys. We report findings, but no accrediting organization has law enforcement powers, nor can they investigate criminal fraud directly, or access and audit pure billing/payment data.

ACHC has provided detailed suggestions of the rule changes necessary at a state and federal level to significantly diminish the potential for fraud and we will continue to work with these regulatory agencies to drive demonstrable change.

What is working

Despite these issues, it is important to reinforce that the vast majority of hospice providers are committed to delivering high-quality, compassionate care. Oversight systems must strike the right balance: Identifying and removing bad actors while supporting the providers who are doing the right thing every day. Not all accreditors are created equal. If an organization is interested in using the accreditation process and associated education to provide better care, due diligence is critical.

At ACHC, we remain committed to continuous improvement in our own processes, including enhanced auditing, targeted validation surveys and ongoing collaboration with state and federal partners. When we identify concerns, we act, and we share those findings with the appropriate authorities to protect patients and program integrity.

Restoring trust in hospice care will take sustained, coordinated effort. It requires transparency about the challenges, clarity about roles and responsibilities, and a shared commitment to strengthening the system. Patients and families deserve nothing less.

Sincerely,