Hospice with Jim

Host of Dying for Profits Podcast. Former hospice chaplain, COO & CEO. 15 years on the inside. Building a new way to provide end-of-life care.

[Hospice with Jim @hospicewithjim]

A grieving son asked how hospice workers can endure such difficult moments daily. The answer? Showing up for those who need us most. That's the only reason that ever matters. #HospiceCare #Compassion

[Hospice with Jim @hospicewithjim]

The Medicare hospice benefit promised you six things: a nurse, a doctor, a social worker, a chaplain, an aide, and bereavement support for your family.
That is not a courtesy. It is what you have a right to expect. #HospiceCare #EndofLife

[Hospice with Jim @hospicewithjim]

The doctor just said it's time for hospice.
Most families go quiet. That silence becomes the thing they regret for years.
Instead, in week one: one honest conversation. "I love you, I'm scared too, I'm not going anywhere."
80 guides for families.
https://t.co/9W5ZCKXZ4x

[Hospice with Jim @hospicewithjim]

@SkylineReport Congress already wrote the targeted version. The Hospice CARE Act proposed a moratorium with specific exceptions for underserved areas. The administration moved without it. The scalpel existed. It just wasn't used.

[Hospice with Jim @hospicewithjim]

A medical director's actions speak volumes. Genuine engagement signals clinical rigor, while signing off without review signals a lack of it. Both messages are received, but only one is truly visible to oversight.

[Hospice with Jim @hospicewithjim]

Hospice care can be mission-driven, prioritizing patient outcomes and staff needs, or margin-driven, focusing on admissions and cost. The message received by clinical staff is clear: in margin-driven hospices, clinical outcomes are secondary. #HospiceCare #HealthcareLeadership

[Hospice with Jim @hospicewithjim]

Nurses carrying 22 patients make daily triage decisions, shortening visits and compressing documentation due to impossible workloads. This erodes standards and leads to moral injury. The system, not the nurse, is the issue when capacity is overlooked for growth.

[Hospice with Jim @hospicewithjim]

A hospice nurse caring for over 18 patients cares about everyone. That doesn't fix the math. Hospice integrity without the structure to sustain it isn't a system. It's a prayer.

[Hospice with Jim @hospicewithjim]

@jamesabeckett @grcastleberry @EthanJago3 Just downloaded it. The Spain story alone is worth it. A scandal accidentally made them the healthiest country on earth while America went the opposite direction. We didn't stumble into this crisis. We were led here.
Who else had no idea how deep this goes?

[Hospice with Jim @hospicewithjim]

@Newsweek The "bad actors vs. access" framing is a false choice.
CMS already collects the data that would identify bad actors. It just doesn't publish it in a form families can use.
Transparency protects access AND patients. That's the whole argument.
I've spent over 16 years in hospice.

[Hospice with Jim @hospicewithjim]

It started in California. Then Nevada went up 7x. Then Arizona. Then Texas. Now Georgia and Ohio are under federal enhanced oversight. CMS has identified 6 states. The networks don't stop; they relocate. That's not a state problem. That's a payment structure problem. Over $200/day. No visit verification. Unchanged since 1982

[Hospice with Jim @hospicewithjim]

@eclipsethis2003 The fraud migration is real and documented. When enforcement tightens in one state, the networks move because the payment system exists in all 50 states. This isn't a California problem. It's a Medicare design problem. No visit verification. Unchanged since 1982.

[Hospice with Jim @hospicewithjim]

@FBIHouston The FBI is right, but the deeper problem is structural. A single Medicare enrollment number generates about $225/day. No services required. The payment model was designed in 1982. The fraud it enables is still running in 2026. Families: check your Medicare Summary Notice.

[Hospice with Jim @hospicewithjim]

In many organizations, the doctor doesn't know a patient was admitted until the IDT meeting. The nurse assessed, the nurse decided, and the admission is done. The doctor signs off later. That's not a criticism of nurses. It's the operational reality nobody talks about.

[Hospice with Jim @hospicewithjim]

@eclipsethis2003 The migration pattern is real and documented. When enforcement concentrates in one market, operators relocate. Same networks, new ZIP codes. We covered exactly this in the series. LA County had 1,923 hospice providers. Fraud doesn't end when it leaves California. It reorganizes

[Hospice with Jim @hospicewithjim]

I've been in rooms with hospice operators who put someone else's name on every ownership document. Prior sanctions. Prior investigations. They used trust as a legal buffer. That's not a conspiracy theory. That's a documented fraud pattern. And I watched it.

[Hospice with Jim @hospicewithjim]

The hospice per diem was designed for nonprofits whose incentive was mission. Private equity found it and optimized it for margin.
That is not an accident. That is a policy gap.
And until the payment model changes, this outcome repeats.

[Hospice with Jim @hospicewithjim]

Extend EVV to hospice. Track hospice ownership in real time. Fund surveys that match the fraud risk.
Every recommendation has been on record for a decade.
The gap is not in the analysis. It's in the will to act.

[Hospice with Jim @hospicewithjim]

Dr. Oz said the most important whistleblowers are industry insiders who know how the system gets manipulated.
I spent 15 years in hospice from Chaplain to CEO. I watched a private equity acquisition from the inside. I know what the billing looks like, what the recruiting looks like, and what leadership looks like when it stops asking the right questions.
That's why I built this.
https://t.co/CK1uArRd6t | #DyingForProfits #HospiceFraud #HospiceReform

[Hospice with Jim @hospicewithjim]

Pausing hospice enrollment feels like action.
It isn't.
The operators committing fraud today are already enrolled. Already billing. Some have been for years.

A pause stops new bad actors from entering. It does nothing about the ones already inside.
Enrollment screening was broken before the pause. It will be broken after.