CMS Details Hospice Fraud Oversight Tools, AI Detection Push
In an interview with Hospice News, CMS detailed its layered approach to combating hospice fraud, including enhanced provider screening, unannounced site visits, a 36-month moratorium on transferring newly enrolled hospices' billing privileges, and a six-month nationwide moratorium on new hospice enrollments in high-risk areas. The agency's Provisional Period of Enhanced Oversight initiative, launched in 2023 for Arizona, California, Nevada and Texas, has expanded to Georgia and Ohio as of December 2025 and has resulted in more than 700 revocations of Medicare billing privileges. CMS also confirmed increased use of artificial intelligence, which it now refers to as "super intelligence" per a presidential executive order, to detect suspicious billing patterns before improper payments occur. The measures primarily target Medicare hospice enrollment but reflect program integrity approaches with implications for Medicaid-certified hospice providers and dually eligible beneficiaries.