Dr. Oz targets Medicare fraud with a focus on California hospices Image By HPN Staff Key Points CMS under Dr. Mehmet Oz is intensifying efforts to combat Medicare fraud, especially in hospice care where schemes include enrolling non-terminal patients or using stolen identities California, particularly Los Angeles County, is a major focus due to rapid hospice industry growth and significant questionable billing, with investigations revealing hundreds of providers showing potential fraud indicators The crackdown reflects a broader federal push to address Medicare and Medicaid fraud, increasing tensions between federal oversight and state responsibility for monitoring providers and safeguarding taxpayer funds Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, recently announced the agency will crack down on Medicare providers committing fraud, with a particular focus on hospice care. Hospice fraud typically involves billing for patients who are not terminally ill or using stolen identities to enroll people in hospice programs without their knowledge. Federal officials say the rapid expansion of hospice services with limited state oversight in some areas has created opportunities for abuse. “This administration under President [Donald] Trump is not going to tolerate taxpayer dollars being stolen because people aren’t paying attention anymore. We’re focused on this,” Oz said in a video posted on X. The administration is focusing heavily on California, highlighting Los Angeles County, where Oz cited as much as $3.5 billion in questionable billing. CMS later clarified that not all of that amount is considered fraudulent and that an “evidence-based” investigation still needs to be completed. Auditors in Los Angeles County, cited by a CBS News investigation, estimated suspected fraud closer to $105 million in a single year. Why it matters California has an unusually large number of hospice providers, particularly in Los Angeles County, where the industry has grown rapidly in recent years. A CBS News investigation found that more than 600 of the roughly 1,800 hospice agencies in the county displayed warning signs associated with fraud. These signs include multiple providers at one address, clustering in certain areas, low patient counts, patients discharged alive at unusually high rates, excessive billing and staff shared across companies. State officials, led by Gov. Gavin Newsom, say California is taking steps to address the issue and recover taxpayer dollars. Nearly 280 hospice licenses have been revoked in recent years, and the state has increased scrutiny of new providers. Oz said his approach will go further, aiming to cut off federal Medicare payments to states where large amounts of fraud are found. He warned on a recent podcast that California could lose “hundreds of millions of dollars” in funding if it does not take stronger action to investigate and prevent abuse. The bigger picture The focus on California is part of a broader federal push to address fraud in Medicare and Medicaid. Similar measures have been taken in Minnesota, where federal officials delayed roughly $260 million in Medicaid payments amid allegations of misuse. The dispute highlights a tension between federal oversight and state administration. Medicare and Medicaid are largely funded by federal taxpayers, but states are responsible for overseeing providers. “While states do have a duty to steward federal and state taxpayer dollars, responsibly, it is federal oversight that is necessary to root out systemic fraud,” said Congressman John Joyce (R-PA), chairman of the House Energy and Commerce Subcommittee on Oversight and Investigations, at a congressional hearing this week. As federal scrutiny increases, political debate is intensifying over the extent of fraud and how states are responding, including state efforts to recover improper payments and prevent abuse before it occurs. SUGGESTED STORIES Restoring access to supplemental oxygen in Medicare This is a lightly edited excerpt of testimony recently provided to the U.S. House’s Energy and Commerce Health Subcommittee hearing titled, “Legislative Proposals to Support Patient Access to Medicare Services.” On April 10, 2025, Representatives David Valadao, Julia Read more Fraud detection and its impact on Medicare: Lessons from Operation Gold Rush Fraud is not an abstract budget problem. It creates real harm: confusion for beneficiaries, delayed or denied medically necessary services, and higher costs that ultimately flow back to taxpayers and families through premiums and cost sharing. It also harms accountable care organiz Read more GAO says ACA fraud is rampant Congress is expected to tackle the extension of Affordable Care Act health insurance benefits this month. Those subsidies expired on Dec. 31. 2025. But as Congress debated whether to extend the ACA benefits, the Government Accountability Office (GAO) echoed reports f Read more
Restoring access to supplemental oxygen in Medicare This is a lightly edited excerpt of testimony recently provided to the U.S. House’s Energy and Commerce Health Subcommittee hearing titled, “Legislative Proposals to Support Patient Access to Medicare Services.” On April 10, 2025, Representatives David Valadao, Julia Read more
Fraud detection and its impact on Medicare: Lessons from Operation Gold Rush Fraud is not an abstract budget problem. It creates real harm: confusion for beneficiaries, delayed or denied medically necessary services, and higher costs that ultimately flow back to taxpayers and families through premiums and cost sharing. It also harms accountable care organiz Read more
GAO says ACA fraud is rampant Congress is expected to tackle the extension of Affordable Care Act health insurance benefits this month. Those subsidies expired on Dec. 31. 2025. But as Congress debated whether to extend the ACA benefits, the Government Accountability Office (GAO) echoed reports f Read more
