The agency said the move is part of the administration’s crackdown on fraud, waste, and abuse in the Medicare program.
The Centers for Medicare & Medicaid Services (CMS) announced Wednesday that it would implement a six-month, nationwide data-driven moratoria on new Medicare enrollment for hospices and home health agencies. The action will allow the agency to temporarily halt the entry of new providers into high-risk categories, a major source of fraud, according to CMS. Details about the temporary pause will be published in the Federal Register on Friday, May 15.
“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 in the announcement. “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 freeze, CMS will intensify targeted investigations, deploy advanced data analytics, and accelerate the removal of hospice and home health agencies providers from the Medicare program that are suspected of committing fraud. The approach will also prevent the ability of “bad actor operators” to evade detection by shifting across state lines.
The moratoria will affect all applications for initial Medicare enrollment and certain changes in majority ownership, which CMS said are frequently used to obscure control by bad actors. CMS said the freeze will not impact current enrollments, and existing providers can continue to deliver services to Medicare beneficiaries.
The announcement comes in the wake of a similar moratorium to prevent fraudulent Medicare billing by certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) companies.
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CMS said the freezes are part of the agency’s 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.
In addition, CMS has taken the following actions to address fraud in hospices and home health agencies:
- Revoked or deactivated hundreds of hospices and home health agencies engaged in improper or fraudulent activity.
- Conducted nationwide hospice site visits to verify operations and identify suspicious activity.
- Tightened oversight of newly enrolled Medicare hospice providers in states with elevated fraud risk, including Arizona, California, Georgia, Ohio, Nevada, and Texas.
- Launched a new, publicly available hospice scoring system to increase transparency and identify providers with troubling patterns of utilization, quality, or compliance.
- Implemented enhanced enrollment screening measures for high-risk home health agencies, including site verification of reported practice locations and fingerprinting-based background checks.
- Expanded a demonstration project that allows pre- and post-claim review of home health agencies claims in Florida, Illinois, Oklahoma, Ohio, North Carolina, and Texas to stop improper payments before they occur.