An Open Letter on Stopping Fraud Before It Starts 

An Open Letter on Stopping Fraud Before It Starts 

From Teresa Harbour, Chief Operating Officer, and Nathan J. DeGodt, President and Chief Executive Officer 
Community Health Accreditation Partner (CHAP) 

Recent testimony before the House Ways and Means Committee underscored a truth that many in healthcare have long understood. Preventing fraud requires stopping bad actors before they enter the system. 

We need better enforcement on entry. We need better enforcement at licensure, at the state level. We need it at the certification, the accreditation agencies. We are not going to convict our way out of this. We have to stop them from entering the system,

stated Sheila Clark, President and CEO – California Hospice and Palliative Care Association.

We agree. At CHAP, that principle has guided our decisions for decades. Accreditation integrity is maintained at the front end of the process through disciplined, patient‑centered safeguards. 

The recent reporting on hospice fraud in California is troubling. It reinforces why early enforcement matters and why accrediting organizations must consistently apply diligent standards within their defined role.  

CHAP did not accredit any hospice or home health organizations operating from the notorious Friar Street address highlighted in recent media coverage and congressional hearing. We purposefully rejected applications tied to that location after a compliance review, in line with current CMS processes. Our decisions to reject these applications emanated from standard, repeatable practices that CHAP applies to every applicant. 

Before any organization advances in our accreditation process, CHAP conducts address validation and ownership verification. These steps are designed to surface red flags early, including multiple agencies operating from a single location, overlapping leadership, or staffing structures. When those reviews raised concerns related to applications at the Friar Street address, CHAP did not move forward. 

In addition, CHAP requires in‑person, on‑site surveys. That commitment is longstanding and deliberate. In 2022, CHAP publicly reaffirmed that position in a formal statement outlining our belief that quality accreditation requires quality time and direct observation, even when virtual inspections were temporarily permitted during the COVID-19 pandemic. We remain committed to on‑site surveying because witnessing clinical capacity –  real patients in real time – can further identify red flags.  

CHAP’s role as an accrediting organization is clear; we maintain a zero-tolerance policy against fraud. We verify that providers meet or exceed Medicare Conditions of Participation (CoPs) at the time of survey and through the renewal process. We do not oversee day-to-day operations, which remain the responsibility of providers, state regulators, CMS, and federal oversight agencies, making beneficiary notification and claims-based tracking recommendations necessary as well.  

When potential indicators of fraud are identified during the application or survey process, we act. When standards are not met, we do not accredit. When appropriate, information is shared with state and federal partners. 

In our formal response to CMS (in response to the Request for Information related to Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH) and in materials shared with Congress, CHAP recommended a focused set of practical, front‑end safeguards to strengthen program integrity without adding new regulatory burden. These recommendations include: 

  • stronger enforcement at entry through address validation and ownership verification 
  • routine use of on‑site surveys with direct observation of care, and  
  • greater access to existing data to identify outlier patterns across states, accrediting organizations, and provider cohorts.  

We also support enhanced information sharing among accreditors, state agencies, and CMS when red flags are identified, along with beneficiary notification tools and claims‑based monitoring to complement accreditation activity. Taken together, these steps prioritize prevention, accountability, and patient protection by stopping fraudulent actors before they enter the Medicare system. 

Enforcing integrity at entry is both achievable and essential, without adding new regulatory burden. 

CHAP remains committed to walking alongside providers who share our mission to deliver high‑quality care in the home and community. We will continue to lead with transparency, uphold diligent practices, and support collective efforts to safeguard vulnerable patients. 

Teresa Harbour 
Chief Operating Officer 

Nathan J. DeGodt 
President and Chief Executive Officer 


Community Health Accreditation Partner (CHAP)