CMS Trains Its Program Integrity Sights on Texas Hospices

California has seen hundreds of hospice “takedowns” and Medicare payment suspensions targeting what the Centers for Medicare & Medicaid Services (CMS) proclaims are a multitude of fraudulent hospices, particularly in LA County. Now, based on recent public statements of CMS Administrator Dr. Mehmet Oz, it appears CMS is poised to train its sights on fraud, waste, and abuse among Texas hospice agencies.

On April 28, 2026 at the National Press Club, Dr. Oz made the point that fraudulent actors operating in one jurisdiction often shift their activities to others as enforcement intensifies. He indicated that as hospice fraud scrutiny increases in California similar schemes may emerge in Texas, making it a growing focus for regulatory and enforcement efforts in that state.

These statements arrive around the time that the Texas Senate Committee on Health and Human Services heard testimony regarding problematic hospice providers in Texas, with live discharge rates of 90% or higher.  

The specific references to Texas by Dr. Oz, as well as the Texas Senate testimony, may signal that CMS will bring its myriad of program integrity fraud detection and prevention weapons to the Texas hospice community.

These tools include Medicare payment suspension based on “credible allegations of fraud,” a standard that is seemingly not difficult for CMS to meet: in fact, CMS often relies solely on data analytics for such evidence to take immediate payment suspension action and then “ask questions later” in its efforts to stop Medicare payments to hospices with suspect data indicators. 

Other tools CMS has used to target hospice fraud and abuse include Provisional Period of Enhanced Oversight (PPEO) audits of new hospices and those hospices that experienced a Medicare-defined change of ownership, 100% changes in ownership and billing reactivations. Multiple hospices, including in Texas but especially in Arizona, California, and Nevada, have had their billing and enrollment privileges revoked (akin to a Medicare termination) after subpar results on an initial review of merely 10 or fewer hospice claims by the Medicare Administrative Contractor.

Many hospices facing billing revocation have appealed those actions through a reconsideration request filed directly with the CMS Center for Program Integrity, but those appeals reportedly have not been acted upon by CMS for the most part. The lack of action may be due to Center for Program Integrity staffing shortages or some other reason but, regardless, the agency inaction raises due process concerns and creates significant ongoing operational issues and delayed justice for those inappropriately swept up by the agency action.

LOOKING AHEAD

The hospice industry has seen various fraud schemes over the years. Legitimate and well-meaning hospices join CMS in its efforts to detect and prevent hospice fraud that weakens the hospice benefit for all. When well-intentioned, high-quality hospices are encompassed within broad anti-fraud initiatives, without sufficient opportunity to demonstrate compliance, it may inadvertently diminish trust in the Medicare program among both providers and beneficiaries.

As CMS searches for the right “titration” on aggressive hospice fraud prevention while giving legitimate hospice providers appropriate protections, it appears Texas may emerge the next CMS program integrity proving ground. Texas hospice providers, as well as hospice providers in other states, should prepare now to be able to quickly respond and support its operations and respond to data analytics that raise program integrity concerns.