On Wednesday, the Centers for Medicare & Medicaid Services implemented a six-month moratorium on new Medicare enrollment for hospices and home health agencies.
The moratorium seeks to temporarily stop the influx of new providers entering the hospice and home care space, which is emerging as a significant source of fraudulent activity, the agency said. During the six-month enrollment freeze, CMS also plans to ramp up fraud investigations and deploy data analytics tools to remove more hospice and home health providers suspected of Medicare fraud.
CMS said the nationwide scope of the moratorium is designed to prevent bad actors from avoiding scrutiny by relocating to different states. The federal government has launched strike forces and investigations into hospice fraud in several states, including California, Florida, Arizona and Nevada.
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“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,” CMS Administrator Mehmet Oz said in a statement.
The freeze applies to new Medicare enrollment applications, as well as certain majority ownership changes, which CMS said can be used to conceal fraud. Current providers that are already enrolled in Medicare won’t be affected.
LeadingAge, an organization representing more than 5,000 senior care providers, said it supports the moratorium, arguing that stronger oversight is needed to eliminate fraud and protect patients.
“We support targeted program integrity efforts that root out bad actors and ensure legitimate providers have the resources they need to deliver quality care. Short-term pauses on new provider enrollees, such as the six-month moratoria CMS announced today, can be appropriate tools to allow the agency time to develop and implement longer-term solutions,” LeadingAge CEO Katie Smith Sloan said in a statement sent to MedCity News on Wednesday.
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Another provider organization, the National Alliance for Care at Home, said it also supports CMS’ efforts to crack down on fraud in the hospice and home health sectors — but warned that a nationwide enrollment freeze could unintentionally limit patients’ access to care, particularly in rural and underserved areas where patient demand is rising or existing capacity is strained.
The group argued that fraud is typically concentrated in specific regions and said CMS should pursue more targeted strategies to go after fraudulent providers.
“CMS must use data-driven, risk-based program integrity measures and focus resources on boots-on-the-ground surveys and enforcement of existing oversight mechanisms that root out the blatantly bad actors without potentially limiting patient access to care or punishing high quality providers operating in good faith,” Jennifer Sheets, CEO of the National Alliance for Care at Home, said in a statement.
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