CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice and Home Health Agency Enrollment Moratoria

CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice and Home Health Agency Enrollment Moratoria

Action Builds on Administration's Whole-of-Government Effort to Crush Fraud and Protect Medicare

In coordination with Vice President JD Vance's Anti-Fraud Task Force, the Centers for Medicare & Medicaid Services (CMS) is taking decisive action to protect Medicare beneficiaries and taxpayer dollars through implementation of a six-month, nationwide data-driven moratoria on new Medicare enrollment for hospices and home health agencies (HHAs). The moratoria will allow CMS to temporarily halt the influx of new providers into these high-risk categories-a key source of fraudulent activity. Today's move continues the Trump Administration's crackdown on fraud, waste, and abuse in the Medicare program by stopping improper billing and preventing bad actors from entering the system.

"We've seen systemic and deeply troubling fraud in the hospice and home health space, with bad actors exploiting some of our most vulnerable Medicare patients and stealing money from the American taxpayer," said CMS Administrator Dr. Mehmet Oz. "Today we're shutting the door on fraud-preventing new bad actors from entering Medicare while we aggressively identify, investigate, and remove those already exploiting them. This is about protecting patients, restoring integrity, and safeguarding taxpayer dollars."

During the six-month moratoria, CMS will intensify targeted investigations, deploy advanced data analytics, and accelerate the removal of hospice and HHA providers from the Medicare program that are suspected of committing fraud. This nationwide approach will also eliminate the ability of bad actor operators to evade detection by simply shifting across state lines. In addition, the moratoria will apply to all applications for initial Medicare enrollment and certain changes in majority ownership, which are frequently used to obscure control by bad actors. The moratoria will not impact current enrollments, and existing providers can continue to deliver services to Medicare beneficiaries.

CMS' announcement today follows our declaration earlier this year of a similar moratorium to prevent fraudulent Medicare billing by certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) companies. With three separate moratoria now in place, CMS has taken some of the most significant fraud prevention actions in the agency's history.

The moratoria are part of CMS' ongoing efforts to stop fraud before it starts, using data-driven prevention and real-time enforcement as part of a coordinated federal approach. Recent CMS action, undertaken in coordination with Vice President JD Vance's Anti-Fraud Task Force, has included the suspension of payments to 773 hospices and 23 HHAs suspected of fraud in Los Angeles alone, representing $70 million in suspended funds thus far.

Additional CMS work to crush fraud in the hospice and HHA areas has included:

• Revoking or deactivating hundreds of hospices and HHAs engaged in improper or fraudulent activity;
• Conducting nationwide hospice site visits to verify operations and identify suspicious activity;
• Heightened oversight of newly enrolled Medicare hospice providers in states with elevated fraud risk, including Arizona, California, Georgia, Ohio, Nevada, and Texas;
• Launching a new, publicly available hospice scoring system to increase transparency and identify providers with troubling patterns of utilization, quality, or compliance;
• Implementing enhanced enrollment screening measures for high-risk HHAs, including site verification of reported practice locations and fingerprinting-based background checks; and
• Expanding a demonstration project that allows pre- and post-claim review of HHA claims in Florida, Illinois, Oklahoma, Ohio, North Carolina, and Texas to stop improper payments before they occur.

Additional information on the Hospice and Home Health Agency moratoria can be found via the Federal Register at: https://www.federalregister.gov/

Learn more about CMS' fraud prevention efforts online at: www.cms.gov/fraud

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