Since the hospice benefit was introduced into the Medicare program, utilization has increased steeply. Previous research suggested that the use of hospice care is growing most rapidly in nursing facilities; however, little was known about the characteristics of the Medicare beneficiaries who receive hospice care in nursing facilities or the hospices that provide care in this setting. A synthesis of research from the U.S. Department of Health and Human Services, Office of Inspector General (OIG) examined Medicare hospice care provided in nursing facilities. Findings are based on analysis of Medicare hospice claims data and medical record reviews. OIG findings suggest that some hospices may be seeking out beneficiaries with particular characteristics, including those with conditions associated with longer but less complex care. Such beneficiaries are often found in nursing facilities. By serving these beneficiaries for longer periods, the hospices receive more Medicare payments per beneficiary, which can contribute to higher profits. The OIG's recommendations for reform include modifying the payment system for hospice care in nursing facilities and targeting monitoring efforts on certain hospices.