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One of the most important transformations in American healthcare is taking place outside hospitals and nursing homes.
Advances in artificial intelligence, telehealth, remote monitoring, home health services, and new care delivery models are making it possible for more Americans to receive high-quality care in the place they most want to be: their own homes.
For seniors, this transformation represents an extraordinary opportunity. Most older Americans want to remain in their homes, maintaining their independence and connection to family and community. Aging in place is not simply a personal preference. It is a matter of dignity and quality of life.
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President Donald Trump recognized this reality when he pledged to help seniors remain in their homes longer. Since returning to office, his administration has taken meaningful steps toward this goal. Earlier this year, President Trump signed legislation extending Medicare’s Acute Hospital Care at Home program through 2030, allowing eligible seniors to receive hospital-level care without leaving their homes. His administration has continued implementation of the GUIDE dementia model, helping patients with Alzheimer’s disease and related conditions remain at home longer while supporting family caregivers. It has also preserved Medicare telehealth flexibilities that allow more care to be delivered directly to patients rather than requiring unnecessary trips to hospitals and clinics.
Together, these initiatives point toward a broader vision for healthcare: bringing care to the patient rather than forcing patients into institutions. For many seniors, this means receiving care in a more comfortable setting while maintaining greater independence and stronger family connections.
Yet the success of home-based care depends on public confidence that these programs are operating as intended. Unfortunately, recent years have revealed that some of the very programs designed to help seniors remain independent have become attractive targets for fraud. Home health services, hospice care, personal care services, and other home-based benefits have increasingly been exploited by bad actors seeking to profit from Medicare and Medicaid.
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The examples are troubling. In Los Angeles County, investigators identified an extraordinary concentration of hospice and home health providers, including more than 100 hospices operating from a single office building. Investigators have also uncovered sophisticated home health fraud networks that repeatedly cycled the same Medicare beneficiaries among multiple agencies to generate new rounds of federal payments while avoiding traditional fraud detection systems.
While it’s not specific to eldercare, the recent announcement that more than 1 million people signed up for Obamacare benefits without valid Social Security numbers is alarming.
Every major expansion of healthcare benefits depends on public trust. If taxpayers conclude these programs are vulnerable to widespread waste and abuse, support for continued expansion will weaken, honest providers will face greater scrutiny, and seniors who rely on these services may ultimately pay the price.
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This is why President Trump’s efforts to combat fraud deserve as much attention as his efforts to expand access.
The administration has launched major healthcare fraud investigations, established a government-wide anti-fraud task force chaired by Vice President J.D. Vance, expanded enforcement efforts in known fraud hotspots, and increased scrutiny of providers suspected of abusing federal healthcare programs. These efforts are not separate from the administration’s broader commitment to helping seniors age in place. They are an essential part of making that vision sustainable.
The administration’s six-month hospice enrollment moratorium should be viewed as an opportunity to strengthen the system. The objective is not to repeatedly extend temporary restrictions, but to use this period to improve provider screening, ownership verification, and oversight so legitimate providers can continue expanding access to care. Success should not be measured by the number of moratoria we impose. It should be measured by whether we build a system strong enough that we no longer need them.
Recent scandals also reveal a deeper challenge. The federal government provides most of the funding for these programs, but oversight responsibilities are divided among states, contractors, accrediting organizations, and multiple federal agencies. When hundreds of providers operate from the same address, suspicious ownership structures persist for years, or known fraud hotspots continue to expand unchecked, it should be clear who is responsible for identifying and investigating those risks.
Strengthening provider enrollment standards, verifying the true owners behind home health and hospice companies, and improving coordination among federal and state oversight agencies should all be important priorities moving forward. Regulators should also modernize fraud detection systems by looking not only at suspicious providers, but also at suspicious patterns of beneficiary enrollment and movement across multiple providers. Artificial intelligence systems could greatly help this effort. Seniors should receive clear notification whenever they are enrolled in home health or hospice services, making it far more difficult for fraudulent operators to exploit beneficiaries without their knowledge.
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America’s aging population will make home-based care increasingly important in the years ahead. President Trump deserves credit both for expanding these options and for recognizing that they must be protected from fraud if they are to achieve their full potential.
Helping more Americans remain in their homes as they age and protecting taxpayers from abuse are not competing priorities. They are two parts of the same mission. If we want more seniors to age with dignity, independence, and security, we must continue expanding home-based care while ensuring that these programs remain worthy of the public’s trust.
Bobby Jindal was the governor of Louisiana from 2008-2016 and a candidate for the 2016 Republican presidential nomination. He chairs the Center for a Healthy America at the America First Policy Institute.
