The Centers for Medicare & Medicaid Services (CMS) recently published a concise “Hospice Fast Facts,” which provides key insights into hospice utilization in the 2024 fiscal year (FY), Medicare payment volumes, and program integrity initiatives.
In the one-sheet paper, we see that Medicare hospice spending exceeded $27 billion in FY 2024, and that roughly 1.8 million Medicare beneficiaries received hospice care during that period. Although the document emphasized that hospice is an essential benefit within the Medicare program, many of the bullet items discussed the concern regarding potential overutilization of hospice services.
For reference, hospice providers are reimbursed on a per‑diem basis, with rates varying according to the type of care delivered, ranging from routine home care to continuous home care, general inpatient care, or inpatient respite care.
The document appears to align with CMS’s expanding program integrity efforts to curb fraud, waste, and abuse among Medicare‑enrolled providers – and in this case, hospice providers. The Center for Program Integrity (CPI) is leading these initiatives, utilizing enforcement actions, provider education, and targeted audits to ensure that program funds are used appropriately.
In the review for FY 2024, CMS identified concerning trends, including improper billing and hospices not being fully operational at their registered addresses. In response to this, they have initiated site visits, claim reviews, and administrative actions for identified hospice agencies that are being flagged with potential concerns for program integrity.
CMS notes that hospice utilization and expenditures have steadily increased in recent years. This growing financial footprint invites heightened oversight, especially as CMS balances access to end‑of‑life care with safeguarding taxpayer dollars. For hospice administrators, clinicians, and compliance officers, the fact sheet serves as a critical reminder of the importance of operational transparency, accurate provider enrollment, and address validation.
It is also important to see how there will likely be ongoing scrutiny of hospice agencies from CPI via audits, reviews, and potential enforcement.
Now would be an important time to proactively review the patient referral and acceptance process, documentation, and billing standards.
While the fact sheet does not delve into future payment update proposals, it complements broader CMS policy initiatives such as upcoming proposed rules for the FY 2026 hospice wage index, payment update percentages, and quality reporting requirements. These forthcoming rules will determine next year’s payment rates, hospice cap limits, and revisions to regulations around physician certification and quality reporting requirements.
EDITOR’S NOTE: The author of this article used artificial intelligence- (AI)-assisted tools in its composition, but all content, analysis, and conclusions were based on the
As the Centers for Medicare & Medicaid Services (CMS) clarifies existing Medicare policies like the Two-Midnight Rule, which guides the appropriateness of inpatient services, some
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