To stop the proliferation of fraudulent hospice and home health agency (HHA) providers bilking the American taxpayer, the U.S. Centers for Medicare & Medicaid Services (CMS), in coordination with Vice President JD Vance’s Anti-Fraud Task Force, has announced a six-month national moratorium on new applications.
Effective Wednesday, the moratorium will also give CMS time to more closely scrutinize the operations of business suspected of fraud who already hold licenses, especially in certain states where fraud it more prevalent and in high-risk categories found to be “a key source of fraudulent activity.”
“The moratoria will not impact current enrollments, and existing providers can continue to deliver services to Medicare beneficiaries,” CMS reassured in a press release.
“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,” CMS Administrator Dr. Mehmet Oz explained.
The Trump Administration’s temporary moratorium also enjoys enthusiastic industry support.
The National Partnership for Healthcare and Hospice Innovation (NPIH), for example, released a statement praising the CMS moratorium:
“The National Partnership for Healthcare and Hospice Innovation (NPHI), the national voice for nonprofit hospice and advanced illness care, applauds the Centers for Medicare & Medicaid Services’ (CMS) announcement of a temporary six-month nationwide moratorium on new Medicare hospice enrollments that will help stop fraudulent operators from exploiting the Medicare hospice benefit.
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“This nationwide approach will also eliminate the ability of bad actor operators to evade detection by simply shifting across state lines and effect changes to stop majority ownership tactics frequently used to obscure control by bad actors.”
As part of its effort to eradicate waste, fraud and abuse in the system, CMS will conduct heightened oversight of newly enrolled Medicare hospice providers in “states with elevated fraud risk,” including:
- Arizona,
- California,
- Georgia,
- Ohio,
- Nevada, and
- Texas.
CMS is also 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.
The moratorium announced Wednesday is the third of its kind issued by the Trump Administration as part of CMS’ ongoing efforts to stop fraud before it starts.
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.
To increase transparency and identify providers with troubling patterns of utilization, quality, or compliance, CMS has launched a new, publicly available hospice scoring system.
