Though the majority of Americans spend the final weeks of their lives in hospice care, the United States only got its first hospice, the Connecticut Hospice, in 1974. Today, just under a half century later, over 5,500 hospices provide services for the dying; in 2020, 1.72 million Americans received care through hospice services, whether in brick-and-mortar inpatient facilities or in the comfort of their homes. (Most people on hospice do pass away at home.)

The United States’ heavily for-profit hospice system would be unrecognizable to Florence Wald and the group of patient-minded nurses, doctors, and clergy who founded the Connecticut Hospice. As of 2020, over 72 percent of hospices are for-profit and approximately 24 percent are nonprofit. Less than 3 percent are publicly owned.

In a new report by the Center for Economic and Policy Research (CEPR), Preying on the Dying: Private Equity Gets Rich in Hospice Care, researchers examined the outsize role that private corporations, and specifically a small but growing group of private equity firms (PEFs), play in the administration of US hospice care. They found that in recent years, private equity has exploited both fragmentation in the sector and gaping holes in oversight left by federal agencies, including the Centers for Medicare & Medicaid Services (CMS) and the Federal Trade Commission (FTC). And though groundbreaking investigations from the Los Angeles Times, the New Yorker, and ProPublica have sounded the alarm on hospice fraud in recent months, too little attention has been paid to issues inherent to the system — in particular, how private equity can so exploit regulatory holes.