Choosing hospice care often means inviting outsiders into the most intimate and vulnerable moments of a family’s life. That level of trust must be protected—not only through compassionate care, but through strong accountability and quality standards that ensure the Medicare hospice benefit works as intended.
As federal scrutiny around hospice oversight continues to intensify, conversations about fraud, abuse and inappropriate enrollment practices have understandably drawn national attention, particularly in states like California, where regulators have identified troubling patterns among some providers. Organizations engaging in unethical or fraudulent behavior should be identified and held accountable. Patients and families deserve confidence that hospice providers are operating with integrity and delivering care grounded in quality and transparency.
At the same time, accountability and access are not competing priorities. Patients and families deserve both.
Despite decades of evidence demonstrating the value of hospice, too many families still access this care only in the final days of life—or never access it at all. While hospice utilization has increased nationally over time, nearly half of Medicare beneficiaries still do not utilize the hospice benefit at the end of life (PDF). Among those who do, median hospice length of stay remains fewer than three weeks, limiting the ability of many patients and families to fully benefit from the emotional support, pain management, caregiver guidance and interdisciplinary care hospice was designed to provide.
And hospice saves money for the Medicare trust, too. A 2026 analysis from the Research Institute for Home Care found that if Medicare beneficiaries elected hospice care just five days earlier, the program could save between $1.19 billion and $1.50 billion annually. Another 2023 analysis (PDF) from NORC at the University of Chicago examining Medicare beneficiaries at the end of life found hospice users had 3.1% lower Medicare spending, or $3.5 billion less in their last year of life.
Trust in hospice care directly affects whether families feel comfortable accessing these services early enough to benefit from the comfort, preparation, support and meaningful connection only hospice offers.
That is why transparency and accountability matter so deeply.
The Centers for Medicare & Medicaid Services (CMS) has already strengthened hospice accountability by doubling penalties for providers that fail to meet quality reporting requirements. Congress is now considering legislation that would more than triple those penalties. Meaningful consequences for noncompliance protect patients, improve transparency and reinforce the industry's commitment to quality care.
Steps must also be taken to ensure hospice programs are meeting required quality reporting standards. CMS has acknowledged that incomplete reporting limits the agency’s ability to accurately measure quality and reduces the information available to consumers making deeply personal end-of-life care decisions.
Transparency should not be optional in a healthcare model built on trust, accountability and patient-centered care. Patients and families deserve meaningful visibility into quality outcomes and care standards when choosing a hospice provider.
At the same time, oversight efforts must be thoughtful and data-driven to distinguish between organizations committed to long-term quality and those exploiting the system. Broad policy responses that fail to make that distinction risk creating unintended barriers to care.
Across the country, hospice organizations continue investing in clinical excellence, interdisciplinary care teams, compliance infrastructure, reporting systems and continuous quality improvement designed to strengthen patient trust and improve outcomes. Hospice programs are also collaborating with health system partners to expand access to high-quality home-based care.
Patients and families should never have to question whether the hospice provider entering their home is guided by compassion, accountability and quality. Protecting the future of hospice care—one of the most compassionate and patient-centered models of care in medicine—requires both strong oversight and strong providers committed to earning and maintaining that trust every day.
Oversight, transparency and compassionate end-of-life care are not competing priorities. Together, they help strengthen trust in hospice care and preserve an essential Medicare benefit for the millions of Americans who depend on it every year.
Mike Asselta is CEO of Compassus. Terri Warren is chief of community services at Providence.