CMS Launches Nationwide Fraud Crackdown With Six-Month Hospice and Home Health Enrollment Moratoria
The federal government is taking one of its most aggressive stances yet against Medicare fraud, and the hospice and home health sector is squarely in the crosshairs.
Working in coordination with Vice President JD Vance's Anti-Fraud Task Force, the Centers for Medicare and Medicaid Services has announced a six-month, nationwide moratorium on new Medicare enrollment for hospices and home health agencies. The move is designed to cut off the entry point for fraudulent providers while the agency intensifies its investigation and removal of bad actors already operating inside the system.
Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz was direct about the reasoning behind the decision, stating that systemic and deeply troubling fraud in the hospice and home health space has been exploiting vulnerable Medicare patients and draining taxpayer money. The moratorium applies to all new initial enrollment applications and certain changes in majority ownership, a common tactic used by fraudulent operators to obscure who is actually running a provider organization. Existing providers and current enrollments are not affected.
The scale of the problem the agency is responding to is significant. In Los Angeles alone, Centers for Medicare and Medicaid Services suspended payments to approximately 800 hospices and home health agencies suspected of fraud, organizations that were collectively responsible for $1.4 billion in Medicare spending last year. So far, $70 million in payments have been suspended.
This is the third moratorium Centers for Medicare and Medicaid Services has put in place, following a similar action earlier this year targeting certain durable medical equipment, prosthetics, orthotics, and supplies companies. The agency says the nationwide scope of the current moratorium is intentional. By applying it across all states simultaneously, fraudulent operators can no longer simply relocate to avoid detection.
During the six-month period, Centers for Medicare and Medicaid Services will deploy advanced data analytics, conduct targeted investigations, and accelerate removals from the Medicare program. The agency has also launched a publicly available hospice scoring system to flag providers with troubling patterns of utilization or compliance and has expanded a pre- and post-claim review demonstration project across Florida, Illinois, Oklahoma, Ohio, North Carolina, and Texas.
Additional details on the moratoria are available through the Federal Register and at cms.gov/fraud.
