Complete Story
04/21/2026
Federal Fraud Crackdown Expands: What Hospice & Home Health Providers Should Know
Federal enforcement activity targeting hospice and home health continues to escalate, with several major developments in the past week reinforcing a clear message: program integrity remains a top national priority.
Most notably, federal officials announced the suspension of 447 hospices and 23 home health agencies in the Los Angeles area, tied to an estimated $600 million in fraudulent Medicare billing. The action reflects ongoing concerns about bad actors exploiting the Medicare benefit, particularly in high-growth markets.
At the same time, policymakers are doubling down on oversight. The House Ways and Means Committee will hold a hearing today, April 21, 2026, focused on Medicare fraud, signaling continued congressional attention on enforcement strategies.
New audit activity is also emerging. CMS contractors have initiated a post-payment review of home health claims for patients with stays of 361 days or longer, requesting extensive documentation across initial and recertification periods. This aligns with broader federal scrutiny of utilization patterns, length of stay, and eligibility.
Adding to the uncertainty, industry discussions are intensifying around a potential hospice enrollment moratorium. While CMS has not confirmed any plans, national conversations reflect growing concern about how to balance fraud prevention with maintaining access to care.
Why it matters
- Federal oversight is accelerating across hospice and home health, both in high-risk regions and nationally.
- Length of stay, eligibility, and documentation continue to be key focus areas for audits and enforcement.
- Policy discussions, like a potential moratorium, could impact access, growth, and operations if pursued.
- Increased scrutiny may affect referrals, payer behavior, and administrative burden, even for compliant providers.
What to do
- Strengthen documentation now: Ensure eligibility, certifications, and face-to-face documentation clearly support the clinical record.
- Review long length-of-stay cases: Confirm recertifications and ongoing eligibility are well supported.
- Prepare for audit activity: Make sure teams are ready to respond quickly and thoroughly to ADRs.
- Align clinical and billing teams: Documentation and claims must tell the same story.
Stay engaged: Watch for updates from LeadingAge and LeadingAge Ohio as enforcement and policy direction evolves. LeadingAge Ohio is actively engaged in hospice program integrity efforts across the state. If you are interested in being involved, please reach out to Lindsey Buzzard, Director of Home Health & Hospice, at lbuzzard@leadingageohio.org or Susan Wallace, CEO, at swallace@leadingageohio.org.