What CMS’s hospice and home health Medicare freeze means for the industry

As part of the Trump administration’s plans to target fraud in Medicare and Medicaid programs, the Centers for Medicare and Medicaid Services (CMS) on May 13 announced that rather than the standard enrollment process, hospice and home care providers won’t be able to apply to be in Medicare for six months.

CMS classifies hospice and home health as “high-risk” areas for fraud, and pausing new enrollment will give the agency time to root out bad actors, the agency said in a press release.

“During the six-month moratoria, CMS will intensify targeted investigations, deploy advanced data analytics, and accelerate the removal of hospice and [home health] providers from the Medicare program that are suspected of committing fraud,” the release reads.

While individual states have previously issued similar moratoriums with varying lengths of time, nationwide bans are very uncommon, according to Nicole Liebau, resource center strategic partnership and engagement director at Senior Medicare Patrol, a government-funded program designed to prevent, detect, and report Medicare fraud and abuse. She said the pauses for hospice and home health—as well as a moratorium CMS issued earlier this year pausing Medicare enrollment from certain medical supply companies—are the only nationwide moratoriums she could find in CMS’s history.

Why hospice and home health? CMS is targeting the areas specifically because there’s a significant amount of suspected Medicare fraud among them, Liebau said.

Hospice fraud has a higher likelihood of impacting patients than other types of fraud, according to Liebau, because if a patient is incorrectly enrolled in hospice care, they are no longer eligible for curative care.

The industry responds. The National Alliance for Care at Home, which represents both hospice and home health providers, said in a statement that while it supports efforts to root out fraud, “an enrollment moratorium does not distinguish between bad actors and compliant providers and will ultimately reduce competition and slow innovation.”

“More importantly, an enrollment moratorium raises serious access-to-care concerns in areas where patient demand is growing or existing capacity is already strained, leading to longer wait times, reduced service availability, and fewer choices for patients—particularly in rural or underserved communities,” the statement continued.

CMS needs to find “targeted strategies” in areas known to have high levels of fraud, instead of targeting the entire country, according to the Alliance.

Tim Rogers, president and CEO of the Association for Home and Hospice Care of North Carolina, told Hospice News in May that the negatives of the moratorium outweigh the positives and can be “detrimental to cast everyone under the same light.”

However, not every home health and hospice organization opposes the moratorium. Katie Smith Sloan, president and CEO of nonprofit aging services provider LeadingAge, told Hospice News that fraud is “inexcusable” and her organization supports “the administration’s goal of preventing further attacks on programs designed to protect the vulnerable.”

And Ricardo Carcas, assistant special agent in charge of the Medicare Strike Force, a federal initiative created to better detect and combat fraud, told Healthcare Brew that the moratoriums “have been a huge tool for us and for CMS to prevent these fraud schemes.”