CMS finalizes FY2027 hospice pay rule, locks in SSVI fraud-scoring system
Plus: For-profit hospices run 167% higher non-hospice spending per day than nonprofits. The day's rules, money, and enforcement, sourced and tiered below.
Plus: For-profit hospices run 167% higher non-hospice spending per day than nonprofits. The day's rules, money, and enforcement, sourced and tiered below.
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American Health Intel
Rules · Money · Medicine · Decoded daily
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| The Service Line |
Friday, August 7, 2026 |
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CMS finalizes FY2027 hospice pay rule, locks in SSVI fraud-scoring system
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Plus: For-profit hospices run 167% higher non-hospice spending per day than nonprofits. The day's rules, money, and enforcement, sourced and tiered below.
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Rule Confidence: High
The Medicare agency CMS finalized next year's hospice pay rule this week, raising rates 2.3%, and locked in a new fraud-scoring system for nearly every US hospice exactly as it had proposed.
The Service and Spending Variation Index scores each hospice 0 to 16 on nine claims-based measures, including length of stay, live discharges, and non-hospice Medicare spending. Effective October 1, 2026.
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Why it matters
CMS just gave itself a systematic way to flag hospices for fraud risk, using the same rule that sets next year's payment rates. Watch how fast these scores turn into audits.
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Report Confidence: High
The number CMS used to justify its new hospice fraud score: for-profit hospices, the end-of-life care agencies Medicare pays per day, spent nearly 167% more per day on non-hospice Medicare services than nonprofit hospices did.
Total non-hospice spending on hospice patients hit $2.8 billion in fiscal year 2024, up sharply from two years earlier. CMS is now scoring every hospice against this pattern.
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Why it matters
This is the exact data gap CMS used to build its new hospice fraud score, so it is now a benchmark every hospice, not just the ones under investigation, will be measured against.
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