The Centers for Medicare and Medicaid Services has temporarily halted the enrollment of providers of hospice care and home health agencies into the Medicare program, effective May 13.
The action comes as part of a crackdown on fraud, waste, and abuse in what the agency considers high-risk categories, meaning significant sources of fraudulent billing.
“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,” Dr. Mehmet Oz, administrator of the agency, said in a May 13 announcement of the action.
The agency will use the six-month moratorium on provider enrollment to identify and remove suspected fraudulent providers from the Medicare program using data analysis.
For a patient to be enrolled in hospice care, Medicare requires a doctor’s certification that the patient has six months or less to live.
Fraudulent providers often enlist doctors to falsely certify that patients have less than six months to live.
The operators may share that information with others so that a patient may be enrolled in multiple hospice programs.
“Doctors know there’s a black market for allowing their licenses to be used to sign people up for hospice, claiming that they’re going to die in six months ... [but] knowing that they’re not going to,” Oz said at an April 28 health care forum.
One-third of all registered hospices in the country are located in the city of Los Angeles, Oz noted.
The moratorium also applies to certain changes in majority ownership of hospices and home health agencies, which the agency stated are often used to hide the identity of bad actors.
The action does not prevent existing hospices and home health agencies from continuing to provide services to Medicare patients.
On April 15, the Centers for Medicare and Medicaid Services suspended payments to 773 hospices and 23 home health agencies based in Los Angeles that are suspected of fraud.
The action has halted about $70 million in suspected fraudulent payments to date, according to the agency.
In conjunction with Vice President JD Vance’s Anti-Fraud Task Force, the agency has also heightened oversight of Medicare hospice providers in Arizona, California, Georgia, Ohio, Nevada, and Texas, which it considers high-risk states.
The moratorium on enrollments applies only to new hospice or home health agencies in the Medicare program.
It is effective for six months but may be extended in six-month increments at the discretion of the Centers for Medicare and Medicaid Services.
