It isn’t new or surprising that the Centers for Medicare and Medicaid Services (CMS) has initiated a provisional period of enhanced hospice oversight (PPEO) for hospice providers, considering that the Office of Inspector General (OIG) has been looking at hospice care for years. It appears the latest target for CMS may be the state of Georgia—so buckle up, Georgians! As Katie Wehri, vice president of regulatory affairs, quality and compliance for the National Alliance for Care at Home, explained at the 2025 Alliance Financial Summit, “If you are from Georgia, do not be surprised if something like this comes to your town soon.”

Currently, four states are subject to PPEO: California, Arizona, Nevada, and Texas. CMS has already expanded hospice payment scrutiny in these four states. California, especially Los Angeles County, has been a hotbed of hospice fraud in recent years. Given the federal administration’s current focus on rooting out fraud, waste, and abuse, regulatory experts warn that hospice and home health are squarely in the crosshairs. It’s widely expected that CMS will expand PPEO beyond the current four states in the near future.

It’s important for providers to understand what this process involves. As care professionals, we are accustomed to scrutiny, but the rules matter—especially under this new model. CMS has updated the scope of providers subject to PPEO, underscoring that this is a new concept requiring attention. CMS also released MLN7867599, outlining the details of the Period of Enhanced Oversight for new hospices in Arizona, California, Nevada, and Texas. For hospice operators, or for senior living communities allowing hospice providers to deliver care inside their centers, the message is clear: stay the course, and do the right things for the right reasons.

The reality is that enhanced hospice oversight is expanding, and more states are likely to join the list soon. Awareness, compliance, and proactive preparation can make all the difference.

Stay well and stay informed!