“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 Dr. Mehmet Oz said in a statement. “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.”The move is related to efforts by Vice President JD Vance’s anti-fraud task force, set up by Republican President Donald Trump to crack down on potential misuse of public funds. It comes as people across the United States have raised concerns about rising health costs and barriers to access, sometimes from the federal government’s own actions. New work requirements in Medicaid, for example, are expected to strain hospitals around the country and result in millions of enrollees losing their health coverage.
Several alleged fraud schemes have been prosecuted in the hospice and home health care categories, and states have acknowledged that it is a legitimate concern. But some have pushed back on the administration’s aggressive tactics and raised concerns that the catchall efforts could needlessly punish law-abiding providers that are trying to serve patients.
The administration contends this freeze and other actions it is taking will help prevent potential fraud in Medicaid and Medicare and preserve funding and resources for people most in need. Under the six-month pause, existing hospice and home health care providers will continue to operate as usual. But CMS said it will “intensify targeted investigations, deploy advanced data analytics, and accelerate the removal” of providers in the category that are suspected of fraudulent activity.
Such a freeze is not unprecedented, said Tricia Neumann, a senior vice president and executive director for the program on Medicare policy at the health care research nonprofit KFF. She said President Bill Clinton’s Democratic administration also imposed a temporary moratorium on home health agencies.
“A brief moratorium gives the administration time to crack down on true fraud and prevent new fraudulent entities from popping up,” she said.
In recent months, CMS has suspended payments to hundreds of hospice and home care agencies in Los Angeles over alleged fraud and issued another six-month moratorium on suppliers of durable medical equipment, prosthetics, orthotics and certain other supplies in Medicare.
The administration also has approached at least five states with investigations into potential health care fraud and halted some $243 million in Medicaid payments to one of them, Minnesota, over fraud concerns. Last month, Oz announced CMS would add to that oversight by requiring all 50 states to share how they planned to revalidate some of their Medicaid providers.
In at least one case, the administration has erred in its accusations against states. In April, CMS acknowledged to The Associated Press that it made a significant error in figures it used to help justify a fraud probe in New York. The acknowledgment deepened doubts in the administration’s methods and raised a common criticism that has been made about the second Trump administration — that it tends to attack first and confirm the facts later.
