Senator Collins Introduces Bill to Combat Medicare Home Health Fraud

Bill would protect the integrity of the Medicare home health care program by stopping fraud before payments are made and helping ensure legitimate providers are fairly reimbursed.

WASHINGTON, D.C. - U.S. Senator Susan Collins introduced legislation today to protect the Medicare home health program from fraud and strengthen access to these important services for the Americans who need them. The Medicare Home Health Payment Integrity and Protection Act would give the Centers for Medicare and Medicaid Services (CMS) additional tools to prevent and detect fraud while helping ensure that legitimate home health agencies are fairly reimbursed for the care they provide.

"When billions of dollars are improperly siphoned from the Medicare home health program, this can undermine the integrity of the payment system used to reimburse legitimate providers and threaten care for the seniors who depend on it. I have long been a strong supporter of home health care, which allows millions of Americans to remain in the comfort, security, and privacy of their own homes, while helping to avoid unnecessary hospitalizations and nursing home admissions," said Senator Collins. "Fraudulent home health providers harm beneficiaries and diminish reimbursements for honest agencies that are already confronting workforce shortages and rising costs. My legislation would give CMS stronger tools to stop fraud before payments are made and prevent fraudulent spending from distorting the data used to reimburse honest agencies for medically necessary care."

"The National Alliance for Care at Home applauds the introduction of the Medicare Home Health Payment Integrity and Protection Act by Senator Susan Collins. This bill corrects longstanding flaws in home health reimbursement and takes a meaningful step toward a home health benefit that is stable and built for how care is delivered today. We strongly support the bill for its payment reforms, as well as measures to protect patients and preserve the integrity of the Medicare home health benefit. Consistent with our community's commitment to provide the highest-quality, person-centered care in the home, we support the bill's goal to strengthen access while focusing on targeted oversight, protecting the legitimate providers who serve patients every day. We look forward to working with Senator Collins, a long-time champion of care at home, to build support for this important and timely legislation," said Jennifer Sheets, CEO of the National Alliance for Care at Home.

"Senator Collins, a longtime champion of Medicare home health, appreciates the shortcomings of current Medicare home health payment approaches, as this bill demonstrates. We are particularly encouraged by its recognition that the standard prospective payment amount requires recalibration. We appreciate Senator Collins' leadership in presenting a much-needed reset of the Medicare home health payment to promote its stability and ensure access. In addition, we also share the desire to address fraud in the home health setting. LeadingAge has long expressed concern about the disproportionate increase in home health providers in Los Angeles County. This bill's oversight provisions are reasonable, appropriately targeted policies that would help maintain the benefit's integrity. Those, along with the important proposed payment changes, will help to ensure support for legitimate providers-including our nonprofit and mission-driven members. We look forward to working with Senator Collins to advance this legislation," said Katie Smith Sloan, President and CEO of LeadingAge.

"VNS Health applauds Senator Susan Collins for introducing the Medicare Home Health Payment Integrity and Protection Act. For more than 130 years, VNS Health has cared for vulnerable New Yorkers in their homes and communities. From rural Maine to urban New York and across the country, older adults face a common and growing challenge: obtaining the skilled care they need to remain safe and independent at home. Yet each year, hundreds of thousands of Medicare beneficiaries are unable to access that care. Senator Collins' legislation offers a thoughtful path forward by addressing years of unjustified payment cuts that have harmed seniors' access to care. It also includes sensible and effective program integrity measures that target bad actors without penalizing responsible providers, undermining access, or jeopardizing the agencies that care for patients with the greatest needs. We urge Congress to advance this important legislation," said Dan Lowenstein, Senior Vice President of Government Affairs for VNS Health.

Despite the rapid aging of the U.S. population, the number of traditional Medicare beneficiaries receiving home health services declined from approximately 3.3 million in 2019 to 2.7 million in 2024. Excluding California, more than 500 Medicare-certified home health agencies closed during that period, a decline of five percent. In California, however, the number of Medicare-certified home health agencies nearly doubled, with almost all of the growth occurring in Los Angeles County.

Although Los Angeles County is home to only two percent of the nation's Medicare fee-for-service beneficiaries, it accounts for nine percent of Medicare fee-for-service home health expenditures nationwide. The Medicare Payment Advisory Commission and the California State Auditor have raised significant concern about fraud and abuse associated with the unusual concentration of home health agencies and spending in the county.

The consequences of this questionable concentration of agencies and spending can extend far beyond Los Angeles County. Fraudulent or improper payments can distort the data underlying Medicare's home health payment system and diminish reimbursements for legitimate providers nationwide. This can fall especially hard on small, rural agencies like those serving many Maine seniors, which already confront workforce shortages, rising costs, and the challenges of providing care across large geographic areas.

Specifically, the Medicare Home Health Payment Integrity and Protection Act would:

• Require that the identity of home health administrators be verified before agencies are enrolled and authorized to provide services;
• Require proof of liability insurance for agencies that exhibit high risk of fraud;
• Provide the Administrator with the authority to determine the factors that indicate that an agency presents an extreme risk of fraud, and to impose heightened screening requirements on such agencies;
• Require much more frequent surveys of newly enrolled home health agencies, agencies that undergo ownership changes, and agencies that reactivate their billing privileges;
• Increase inspections of home health agencies that fail to submit quality data to CMS, or that engage in practices that are aberrant or signal fraudulent behavior;
• Increase financial penalties for failing to report quality data;
• Require accrediting agencies that work with CMS to meet or exceed CMS standards;
• Require CMS training of home health surveyors for accreditation purposes;
• Establish ongoing CMS oversight of accrediting organizations and provide CMS with authority to terminate deficient accreditors;
• Direct CMS to "reset" home health agency payment rates to adjust for fraud in the system as well as changes in the use of home health care since Covid;
• Authorize funding for CMS and federal law enforcement agencies for the investigation and prosecution of organized home health fraud schemes;
• Authorize funding for CMS and its state agency partners to conduct accelerated surveys, enrollment validation, unannounced site visits, and operational verification of home health agencies; and
• Provide CMS with rulemaking authority to carry out its provisions and require it to report to Congress.

Click here to read the complete text of the legislation.

###

• Print
• Email
• Share
• Tweet