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 & Medicaid Services said in an announcement on Wednesday morning that the “data-driven” decision targets a key source of fraud activity. It follows a similar announcement made earlier this year of a moratorium on durable medical equipment, prosthetics, orthotics and supplies companies.
During the six-month window, CMS said it will focus on identifying and investigating bad actors and deploying advanced analytics that help accelerate the removal of hospice and home health providers that are likely perpetrators of fraud.
CMS added that recent action under the broader White House fraud push has suspended payments to 773 hospice providers and 23 home health agencies in the Los Angeles area, totaling about $70 million in funds.
“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,” CMS Administrator Mehmet Oz, M.D., said in the agency’s 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.”
“This is about protecting patients, restoring integrity and safeguarding taxpayer dollars,” Oz said.
CMS said that 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 “certain changes in majority ownership,” which CMS said can be used to “obscure control by bad actors.”
The moratoria will also prevent suspected fraudsters from evading punishment by moving across state lines, CMS said.
The announcement, the agency said, builds on a number of steps CMS has taken of late to address fraud in hospice and home healthcare, including increased oversight in states with elevated risk of fraud, such as Arizona, California, Georgia, Ohio, Nevada and Texas.
CMS is also conducting hospice site visits across the country to monitor operations and potentially identify suspicious behavior. In addition, it expanded a demonstration across several states—Florida, Illinois, Oklahoma, Ohio, North Carolina and Texas—that allowed for pre- and post-claim reviews of submissions from HHAs, which may stop improper payments before they’re made.
The National Alliance for Care at Home, 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 care disruptions for patients and families.” Still, it said the action raises concerns over access to care in high-demand areas and urged CMS to focus its efforts on “high-fraud markets” or actors without catching the rest of the sector in its net.
“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,” Alliance CEO Jennifer Sheets said in the statement.