Mark Vantrees regularly meets his Vietnam War buddies over breakfast, attends his grandchildren’s Little League games, and, when he’s up to it, walks out into his lush front garden, which is filled with seashells from his abalone-diving days.
Time is precious for him. Last year, doctors told the 76-year-old former truck driver he had only six months to live due to a combination of heart failure, lung disease and liver damage. “That was about 11 months ago,” Vantrees said in an interview in May, smiling at the fact that he has cheated death for the time being.
In June 2025, the Vantrees started hospice, which focuses on quality of life for terminally ill patients, with regular visits from a nurse in their home in Novato, California. Medicare is covering those services for him. His hospice caregivers reminded him of the attention his unit received from medical staff in Vietnam.
“We used to call them guardian angels,” he said, “because they took care of you so much.”
But Trump administration allegations of rampant hospice fraud in California have tarnished the industry’s reputation, raising concerns that fewer patients will seek the care they need. Health policy researchers and hospice administrators worry that the negative attention on the industry and the potential for overly punitive regulations could harm California patients and taxpayers.
“The state of fraud has greatly damaged the reputation of hospices overall and has destroyed much of the progress made in destigmatizing hospice,” said Philip R. said Lauren Hunt, an associate professor at the Lee Institute for Health Policy Studies who focuses on hospice care. “Policymakers should pursue targeted strategies that root out fraud and abuse without overburdening the many providers doing the right thing.”
Hospice care faces widespread restrictions. In May the Centers for Medicare and Medicaid Services announced a six-month national moratorium on hospice provider enrollment in Medicare and increased monitoring in California and several other states with “high fraud risk”: Arizona, Georgia, Nevada, Ohio and Texas.
In a statement, CMS spokesman Timothy Foster said state inaction on fraudulent hospice programs necessitated federal intervention. Foster said CMS believes this action will not impact patients’ ability to receive services, with approximately 7,000 hospices still approved across the country, and will help ensure those hospices that remain provide care “to individuals near the end of life.”
“Ensuring patient safety and access to quality hospice and other certified health services is paramount to the work of CMS,” Foster said.
CMS Administrator Mehmet Oz said tough attitude Also protects taxpayers’ money. Studies have concluded Even as for-profit hospices have expanded, the industry has saved Medicare money by offsetting other expensive care. A 2023 University of Chicago report commissioned by industry associations estimated that Medicare patients who used hospice instead of hospitals in 2019 Taxpayers saved over $3 billion.
California is already cracking down on the problems, with Democratic Attorney General Rob Bonta calling hospice fraud “pandemiclast year and this was emphasized The state is “on it.” The state is owning Dharamshala license banned From 2021, Charged to multiple providers with crimes over the years, and implemented emergency rules This June to curb fraud.
Hunt said she has heard from California health care providers who are reluctant to refer patients to hospice because they are not sure the patients will receive high-quality care and has also heard from patients who don’t know which hospice provider they can trust. California is the highest Dharamshala organization of any state – about 2,800 By 2022, according to the California State Auditor’s Office. CMS in the same year 5,800 hospice agencies reported Nationwide.
Hospice administrators in good standing have already found themselves facing questions: A Washington Post investigation in June It was found that the federal government’s new anti-fraud task force has already suspended the licenses of 43 legitimate hospices.
Nevertheless, Hunt and other policy researchers welcome efforts to target unscrupulous operators.
“Although most hospitals are committed to providing high-quality care, there are serious concerns about a subgroup exploiting patients and the system for financial gain,” he said.
According to industry researchers, the hospice industry is uniquely vulnerable to fraud due to inadequate licensing regulations and inadequate monitoring. And with the percentage of the aging population in Medicare increasing rapidly, spending is expected to accelerate over the next 10 years.
The State Auditor’s report in 2022 said most of the rapid growth in operators has been in for-profit hospices. In California, about 94% of hospice providers are now for-profit, a change from 20 years ago, when nonprofits dominate the industry In California and nationally. On average, profit making operators Earn about $2,100 more According to one study, pretax hospice operators make $49 more per patient than for-profit and non-profit hospice operators.
Skelly Wingard, CEO of By the Bay Health, a Northern California nonprofit that provides services to Venterez, acknowledges that fraud is a big problem in the industry. “These organizations that exploited patients were very intelligent,” he said.
But Wingard cautions against losing sight of the bigger picture.
He said, “Hospice, when done well, is one of the most compassionate and meaningful benefits in health care.” “We must work to protect it, not inadvertently undermine confidence in it.”
By the Bay Health has been in business for 50 years and serves approximately 750 hospice patients in the Bay Area. About 89% of them are covered by Medicare, Wingard said, with 3% covered by California’s Medicaid program, Medi-Cal, and the rest by commercial health plans.
At home in Novato, Ventris lifted his shirt to show where a catheter was surgically implanted in his stomach to drain uncomfortable fluid. The hospital trained his wife, Paula Vantrees, a retired career counselor, to attach a suctioning device to the catheter to remove excess fluid. Blake Neier, a hospice nurse from By the Bay, helped me master this technique when she tried it at home for the first time.
Mark Vantrees said, “Paula is the rock of my foundation.”
Nair orders all of Vantree’s medications and reconfigures them when necessary to manage intense nausea and pain attacks. Every week, Nairn checks the surgical incision around the catheter for infection, listens to Ventrez’s lungs, checks his blood pressure, and cleans and dresses the open wounds that sometimes form from the blisters that burst on his legs, a complication of fluid buildup and weakened skin.
Nair helps hospice patients and their families navigate critical junctures. He remembered guiding a patient’s daughter through her mother’s loss of appetite.
“It’s OK if your mom isn’t eating vegetables,” he told the patient’s daughter. “Let her have ice cream if that’s what she wants.”
California’s emergency rules against fraud took effect in late June. In addition to rigorous prescreening of license applicants, they demand minimum professional qualifications for management, high nurse-to-patient ratios, strict rules around physical office space, and other restrictions.
Hunt said the new rules are a step in the right direction but urged caution.
“The wider impact on the industry should be closely monitored, particularly to ensure that well-intentioned, high-quality providers are not placed under undue pressure or forced to close,” he said.
Late one night last year, when Nairn was not available, another hospice nurse from By the Bay Health came to the Vantrees’ home immediately in response to an urgent call from Paula.
“I felt like I was going to die,” said Mark Vantrees, adding that he just had a premonition that he wouldn’t wake up in the morning. His sons were called to his bedside. The family needed reassurance. So a nurse came, examined him, and checked their father’s vital organs.
He was sleeping till midnight.
