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Hospice and home‑health groups tell Congress California shows how fraud displaces care
Summary
Sheila Clark, CEO of CHAPCA, told lawmakers rapid growth in hospices and home‑health agencies in Los Angeles reflects fraud rather than market demand and urged federal reforms including tools to unwind fraudulent hospice elections and keeping fraud‑polluted claims out of payment decisions.
Sheila Clark, president and CEO of the California Hospice and Palliative Care Association (CHAPCA), told the committee that rapid increases in hospice and home‑health providers in Los Angeles are warning signs of systemic fraud.
"Hospice and home health fraud is not merely billing problems. They are beneficiary protection failures," Clark said, arguing that fraudulent enrollment and billing can deny patients appropriate care and erode trust. She cited Los Angeles figures she called alarming: "In Los Angeles, home health payments reached $1,700,000,000 in 2024, about double the 2018 level," and the number of agencies billing Medicare grew sharply.
Clark urged two specific reforms: a federal pathway to unwind fraudulent hospice elections so beneficiaries are not left trapped, and steps to ensure "fraud‑saturated claims data is not used to shape federal payment in hospice and in home health." She also recommended more frequent surveys of newly enrolled hospices, withholding payments from hospices that fail to submit required quality data, and temporary moratoria on new enrollments where fraud risk is high.
CHAPCA framed these as beneficiary‑centered fixes that must be paired with decisive enforcement; Clark said enforcement alone is insufficient if payment policy continues to rely on polluted claims data. The association offered the committee examples it said show how following a beneficiary's claims history can reveal networks of sham entities and misused provider NPIs.
Clark's testimony underlined witnesses' broader call for stronger pre‑enrollment checks, improved state licensure and certification enforcement, and clearer federal remedies for affected beneficiaries.
