Medicare Expands ‘Enhanced Oversight’ To All Hospice Organizations In Four States

To combat fraud, waste, and abuse under the hospice benefit, in September 2024, the Center for Medicare & Medicaid Services (CMS) expanded enhanced oversight and prepayment medical review in Arizona, California, Nevada, and Texas. To help reduce the burden on compliant provider organizations, initial review volumes will be low, and adjusted based on results.

This expansion builds on provisional enhanced oversight in these states that began in July 2023. The provisional oversight affected new hospice provider organizations in the four states. In this program, a Medicare Administrative Contractor conducted a medical claims review before making a payment decision.

The expanded . . .