In 2024, more than a quarter of hospice decedents reached the benefit only inside their last seven days of life, per MedPAC. Hospice marketing regulations follow the payer: Medicare. Senior care is all we do, and Net Solutions Interactive designs hospice marketing around what you may offer a referral source, what your materials must say, and which growth tactics are simply off the table.
Hospice marketing regulations sit on top of ordinary advertising law because the payer is Medicare. Net Solutions Interactive builds hospice marketing programs designed to survive that scrutiny.
Which rules actually govern hospice marketing?
Three separate rulebooks bear on the work. What you may hand a referral source is governed by the federal Anti-Kickback Statute. Who qualifies for the benefit, and who may sign off on that, is governed by the CMS Medicare Benefit Policy Manual — which in turn fixes the outer limit of what you are allowed to advertise. And which specific marketing moves regulators have already singled out as fraud risk is set out in the OIG’s compliance guidance for hospices (1998). Two more apply alongside them: the civil monetary penalty on inducements to beneficiaries, and the physician self-referral (Stark) law for any physician financial relationship.
General advertising law still applies underneath all of that. The difference is consequence: a misleading claim in most industries is a consumer-protection problem, while a misleading claim about the Medicare hospice benefit is a federal health care program problem.
The stakes scale with the benefit’s reach: MedPAC put the 2024 election rate at a record 52.9% of the Medicare decedent population, so hospice marketing draws scrutiny most industries never face.
What does the Anti-Kickback Statute prohibit?
It prohibits knowingly and willfully offering, paying, soliciting or receiving remuneration to induce or reward referrals of items or services payable by a federal health care program, per the HHS Office of Inspector General. “Remuneration” is broad — it is not limited to cash.
The OIG’s hospice guidance names the patterns it looks for. Per-certification or per-referral fees paid to physicians. Free or below-market goods and services provided to referral sources. Anything of value routed to the people who decide where a patient goes. The practical test is not whether a payment feels reasonable; it is whether anything of value moved toward a referral source in a way that could induce referrals.
| Practice | Status | Source |
|---|---|---|
| Paying a physician per certification | Prohibited risk area | OIG hospice guidance |
| Free or below-market services to a referral source | Prohibited risk area | OIG hospice guidance |
| Reviewing residents’ records without permission to solicit | Improper solicitation | OIG hospice guidance |
| Marketing materials omitting eligibility requirements | Against OIG guidance — materials should feature eligibility prominently | OIG hospice guidance |
| Educating clinicians on eligibility recognition | Not among the OIG’s named risk areas | OIG hospice guidance |
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What is patient charting and why is it a violation?
Patient charting is reviewing residents’ medical records at a facility, without patient permission, to identify people who might be hospice-eligible and then soliciting those referrals. The OIG’s hospice compliance guidance identifies it by name as an improper solicitation practice and a fraud risk area.
It is worth naming plainly because it is the rule most often broken by accident. A liaison invited into a facility, handed a census, and asked to “see who might qualify” has crossed the line even with the facility’s blessing — the permission that matters is the patient’s.
What must hospice marketing materials say?
The OIG’s guidance is direct about what belongs on the page and what may not. Eligibility criteria for the Medicare hospice benefit go somewhere a reader meets them early, not somewhere they have to hunt. And two suggestions are off the table entirely: that how long a patient is expected to live carries little weight, or that coverage simply continues without end.
That one requirement disqualifies a great deal of the copy healthcare marketers write by habit. Comfort and dignity cannot carry the opening while the qualifying criteria sit in small print further down. The criterion is narrow: CMS draws it at a prognosis of six months or less should the disease follow its expected course, and the manual limits who may attest to that — a medical doctor or a doctor of osteopathy, nobody else. Put it where a reader will actually encounter it.
Why does the eligibility rule matter commercially?
Because the threshold regulators enforce and the metric operators watch are one and the same. CMS sets eligibility at a prognosis of six months or less on the disease’s expected course. MedPAC’s 2024 figures then show how far from that threshold real enrollment sits: half of all hospice stays closed within 19 days even as the average ran to 99.6 days, and more than a quarter of decedents reached the benefit only inside their last seven days of life.
That gap is the commercial case for compliant marketing. Referrals arriving 19 days before death are legal, appropriate, and worth a fraction of what an eligible patient referred months earlier is worth — per MedPAC, the benefit paid about $191 for each day of care in 2024. Where the patient lives shifts the math further: the same report shows stays averaging 100 days at home, 120 days in nursing facilities, and 174 days in assisted living — which is why facility-facing education is worth doing correctly rather than not at all.
So the compliant activity and the profitable activity are the same activity. Teaching a physician to recognize eligibility earlier sits outside every marketing risk area the OIG names, and it is worth more per referral than anything a prohibited inducement could buy.
What may a hospice legally offer a referral source?
Education, responsiveness, and information about the patients they already sent. Those three are not merely permitted; they are the substance of a compliant program. Teach eligibility recognition for the diagnoses a physician actually manages. Publish a response standard from referral to bedside evaluation and keep it every time. Report back on admission and outcome.
What you may not do is convert any of that into a thing of value flowing to the referrer. An in-service where clinicians are taught eligibility is education; a meal, staffing or service attached to it is remuneration that counsel should review. The same event structured so the practice receives free staffing, free services, or below-market benefit is a risk area. The line is whether the referral source receives value beyond the information itself.
How should a hospice document marketing compliance?
Keep the material, the training, and the log. Retain every version of every outreach piece with its approval date, so you can show what was in market when. Record who was trained on the eligibility and solicitation rules and when. And log referral-source interactions in a way that shows education rather than inducement.
Regulatory changes are the reason that log carries review dates. The rules on this page move: CMS issues a hospice payment rule for every fiscal year, resetting the payment rates and the aggregate cap each October, and the CMS manual and OIG guidance cited here can be revised at any time. Material approved last year was approved against last year’s rules.
So build the review into the calendar instead of waiting for a problem to surface it. Each time CMS publishes the new fiscal-year rule, or the OIG issues new hospice guidance, pull every outreach piece, liaison script and web page that cites a payment figure, an eligibility rule or a coverage claim, check each one against the current text, and log the review date and the reviewer beside the version in market. Any figure that changed, including the MedPAC and CMS payment figures quoted on this page, is updated before the next piece goes out. This page runs on the same routine, which is why its byline carries the date the rules were last reviewed.
The hospice marketing plan template includes a compliance section built for exactly this, and the full hospice marketing guide puts these rules in the context of the wider growth system. If you want the whole program built and documented, we run it for one hospice per market (one city or metro area); outsourced hospice marketing covers how that engagement is structured.
Frequently asked questions
Where is the line on paying a referring physician?
There is no compliant version of it. Paying to induce federal health care program referrals is exactly what the Anti-Kickback Statute forbids, and the HHS Office of Inspector General’s hospice guidance names the forms that recur in this sector: a fee attached to each certification, and goods or services handed to a referral source for nothing or for less than they are worth.
May a liaison read facility charts to find eligible patients?
Not unless the patient has agreed to it. Combing a facility’s resident records for prospects and then soliciting them has a name in the OIG’s guidance — patient charting — and it appears there among the improper solicitation practices and flagged fraud risks. The consent that cures it belongs to the patient, not to the facility.
Who can certify a patient as hospice-eligible?
Certification is restricted to physicians holding an MD or a DO, per the CMS Medicare Benefit Policy Manual. Anyone can start the conversation, but every Medicare hospice admission runs through a physician’s certification.
What are the Medicare hospice referral guidelines?
Medicare’s rules bind a referral at three points. The patient must have a prognosis of six months or less if the disease follows its expected course; that prognosis is certified by a physician holding an MD or a DO, the hospice physician together with the patient’s own doctor when there is one; and nothing of value may move to a referral source to induce the referral, under the Anti-Kickback Statute. Anyone can start the conversation, but the certification decides it.
Must a patient have an attending physician to elect the benefit?
No. Medicare.gov describes certification as a joint act of the hospice physician and the patient’s own doctor whenever the patient has one. Where nobody holds that attending role, the CMS manual lets certification rest on the hospice’s own physician — its medical director or the physician member of the interdisciplinary group.
Is hospice a lucrative business?
It can be, and the eligibility rule is where that is decided. MedPAC’s 2024 figures put the benefit at about $191 for each day of care, but half of all stays closed within 19 days against an average of 99.6, and more than a quarter of decedents reached the benefit only in their last seven days. Stays also average 174 days in assisted living, 120 in nursing facilities and 100 at home. A hospice whose referral sources recognize eligibility earlier earns more per referral, and teaching that recognition is the compliant growth activity this page describes.
Are hospice marketing regulations different from home health rules?
They overlap on the Anti-Kickback Statute and diverge on eligibility. Hospice carries the six-month prognosis certification and the OIG’s hospice-specific guidance, which is why materials that work for a home health agency often need rewriting before a hospice can use them.
The bottom line
Hospice marketing regulations are less restrictive than most operators fear and more specific than most agencies know. Teaching eligibility appears nowhere on the OIG’s risk list, and is among the highest-return growth activities. Paying for access is prohibited, and the OIG has published exactly which patterns it looks for.
Build the program around education and responsiveness and the compliance question becomes far easier. Book the 15-minute market walkthrough, or work from this page — either is fine, and if the numbers do not work for your market, we will say so on the call.