The Trump administration has issued a six-month moratorium on hospice and home health agencies enrolling in Medicare as part of its efforts to combat fraud.
The Centers for Medicare and Medicaid Services said in an announcement Wednesday morning that the “data-driven” decision points to a key source of fraudulent activity. It follows a similar announcement earlier this year of a moratorium on durable medical equipment, prosthetics, orthotics and supply companies.
During the six-month period, CMS said it will focus on identifying and investigating bad actors and implementing advanced analytics that will help accelerate the elimination of hospice and home health providers who are likely perpetrators of fraud.
CMS added that a recent action under the broader White House fraud initiative has suspended payments to 773 hospice providers and 23 home health agencies in the Los Angeles area, totaling approximately $70 million in funds.
“We have seen systemic and deeply troubling fraud in the hospice and home health care space, with bad actors exploiting some of our most vulnerable Medicare patients and stealing money from American taxpayers,” CMS Administrator Dr. Mehmet Oz said in the agency’s news release. “Today we are closing the door on fraud, preventing new bad actors from entering Medicare while we aggressively identify, investigate and root out those already exploiting them.”
“This is about protecting patients, restoring integrity and safeguarding taxpayer dollars,” Oz said.
CMS said the moratorium will not affect providers currently enrolled in Medicare and they can continue to offer key services to members. It will apply, however, to new applicants for participation and to “certain changes in majority ownership,” which CMS says can be used to “hide control by bad actors.”
The moratorium will also prevent suspected scammers from evading punishment by crossing state lines, CMS said.
The announcement, the agency said, builds on a series of actions CMS has taken recently to address hospice and home health fraud, including increased oversight in high-fraud-risk states such as Arizona, California, Georgia, Ohio, Nevada and Texas.
CMS is also conducting visits to hospice sites across the country to monitor operations and potentially identify suspicious behavior. Additionally, it expanded a demonstration in several states (Florida, Illinois, Oklahoma, Ohio, North Carolina and Texas) that allowed for pre- and post-claim reviews of HHA submissions, which can stop improper payments before they are made.
The National Alliance for Home Care, in a statement responding to the news, said it welcomes the administration’s scrutiny and appreciates that “providers will still be able to conduct face-to-face recertification visits via telehealth during the enrollment moratorium, which will help avoid unnecessary disruptions to care for patients and their families.” Still, he said the action raises concerns about access to care in high-demand areas and urged CMS to focus its efforts on “high-fraud markets or actors” without trapping the rest of the sector in its net.
“CMS should use data-driven, risk-based program integrity measures and focus resources on field surveys and enforcement of existing oversight mechanisms that root out blatantly bad actors without potentially limiting patients’ access to care or punishing high-quality providers who operate in good faith,” Alliance CEO Jennifer Sheets said in the statement.
