California is the epicenter. 12 of the 20 tracked cases are California based, including the $267M Operation Skip Trace ring, the largest single case in this reporting period.
Texas runs second. The $110M UPHC scheme in Houston and the Four Winds Hospice kickback case in San Antonio brought 10 defendants across six hospice entities into federal court.
Non-terminal patient enrollment is universal. Every single hospice billing fraud case in the dataset involved enrolling patients who were not actually terminally ill.
Operation Never Say Die hit hard in April 2026. Five coordinated California cases totaling $50M+ were announced with the Vice President Anti-Fraud Task Force.
221 hospices suspended in Los Angeles alone. CMS moved in parallel with the April 2026 arrests to suspend billing privileges across LA County providers.
Recurring operators are a red flag. Nita Palma, thrice convicted, operated three new sham hospices through a straw CEO husband while incarcerated.
Identity theft is escalating. Operation Skip Trace used dark-web stolen identities to enroll out-of-state Medi-Cal beneficiaries through 14 straw-owned hospice companies.
The Data Fusion Center changed detection. The DOJ Health Care Fraud Data Fusion Center, established June 2025, now uses AI and CMS billing data to flag hospice outliers.
CMS Enhanced Oversight expanded. In December 2025, CMS added Georgia and Ohio to the original hotbed states of California, Arizona, Nevada, and Texas.
Arizona cases targeted hospice patients as victims. The Apex Medical $1.2B wound graft case and its $1B spinoff applied unnecessary allografts to hospice patients, some of whom died the same day.