Hospice & Home Health News 2026May14

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/

Tip Sheet: Proposed FY27 Hospice Wage Index Rule Comments. To help members in crafting comments to the Centers for Medicare and Medicaid Services (CMS) on the FY27 Hospice Wage Index proposed rule, LeadingAge has developed this resource with tips and links to additional resources. Access the tip sheet here.

OMB Receives CY2027 Home Health Proposed Rule. On May 11, the Office of Management and Budget (OMB) received the CY2027 Home Health Proposed Rule. This is the first step in federal review of rulemaking. LeadingAge anticipates this rule will be posted late June to early July. Based on the title the rule will contain additional updates for the Home Infusion Therapy program. Link to the regulatory review page here.

Two Percent Sequestration Deduction Applied Twice on Home Health, SNF, Hospice Claims. Multiple Medicare Administrative Contractors overseeing home health payments have reported the two percent sequestration deduction has been applied twice on recently processed claims, beginning in mid-April. This is specific to Part A institutional providers including skilled nursing, home health and hospice claims (the dollar deducted for sequestration is shown in value code 73). Home Health and Hospice MAC's CSG, Wellpoint Federal (formally NGS), and Palmetto, have each included an issue of log item on their websites for more information. The MACs state no further provider action is needed. The Fiscal Intermediary Standard System (FISS) maintainer is identifying claims underpaid incorrectly due to this issue. Identified/impacted claims will be adjusted starting on May 14, 2026. Members are advised to review their claims from the last month and ensure proper payments are reprocessed.

OASIS Q&As Address AI Usage, Falls Reporting, and Skin Substitutes. On April 21, CMS published new Q&As for correctly coding the home health OASIS. In the most recent update of the OASIS CMS addressed several high priority issues for home health agencies including the adoption of AI in clinical workflow, changes to the reporting of falls, and skin substitutes. Read more about these important updates.

Here is your weekly  Home Health Weekly Recap from National.

Here is your weekly  Hospice Weekly Recap from National.