The Centers for Medicare & Medicaid Services is imposing a six-month nationwide moratorium on new Medicare enrollments for hospices and home health agencies as part of a broader effort to combat fraud, waste and abuse in the Medicare program.
CMS said the temporary freeze, announced in coordination with Vice President JD Vance’s Anti-Fraud Task Force, is intended to stop fraudulent providers from entering the Medicare system while the agency intensifies investigations into existing providers suspected of improper billing practices.
Here are seven things to know about the crackdown:
- According to a May 13 CMS news release, the moratorium applies to all applications for initial Medicare enrollment for hospices and home health agencies, as well as certain majority ownership changes that CMS said are often used to conceal control by fraudulent operators. Existing providers will not be affected and may continue serving Medicare beneficiaries.
- CMS said the nationwide approach is designed to prevent operators suspected of fraud from relocating across state lines to avoid detection. During the six-month moratorium, the agency said it plans to expand targeted investigations, use advanced data analytics and accelerate the removal of providers suspected of fraudulent activity from the Medicare program.
- The announcement follows a similar moratorium CMS implemented earlier this year targeting certain durable medical equipment, prosthetics, orthotics and supplies companies. CMS described the actions as some of the largest fraud prevention measures in agency history.
- The agency also said recent anti-fraud efforts in Los Angeles led to the suspension of payments to 773 hospices and 23 home health agencies suspected of fraud, representing approximately $70 million in suspended funds.
- Additional anti-fraud measures outlined in the news release include revoking or deactivating providers engaged in fraudulent activity, conducting nationwide hospice site visits and increasing oversight of newly enrolled hospice providers in Arizona, California, Georgia, Nevada, Ohio and Texas.
- CMS also said it launched a public hospice scoring system aimed at identifying providers with concerning utilization, quality or compliance patterns.
- Other efforts include enhanced enrollment screening measures for high-risk home health agencies and expansion of a demonstration project allowing pre- and post-claim reviews of home health claims in several states, including Florida, Illinois, North Carolina, Ohio, Oklahoma and Texas.
On May 14, a spokesperson for the Texas Association for Home Care & Hospice shared a response with Becker’s regarding CMS’ move. The organization said it strongly supports federal efforts to root out fraud and remove bad actors from Medicare home health and hospice programs, but urged CMS to “take a targeted, risk-based, data-driven approach that protects patients and the Medicare program while preserving access to legitimate care, especially in rural and underserved Texas communities.”
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