CMS extends Medicare enrollment freeze as hospice and home health fraud probe deepens
The Trump administration has extended its nationwide moratorium on new Medicare enrollments for hospice and home health agencies by six months, keeping the brakes on fresh participation while federal investigators continue to examine fraud, waste and abuse in two sectors long treated as high-risk for program integrity lapses.
The move gives the Centers for Medicare & Medicaid Services more time to use targeted investigations and advanced data analytics to identify suspicious billing and ownership patterns. CMS said the original moratorium window produced progress, but not enough to conclude that the conditions driving the order have resolved. In practical terms, the agency is keeping the gate closed for new entrants while it tries to separate legitimate providers from operators exploiting Medicare beneficiaries and siphoning public funds.
A single policy choice can change the economics of an entire sector.
CMS framed the extension as a patient-protection measure first and a payment-control action second. Administrator Mehmet Oz, M.D., said the agency has made real progress over the past six months, yet fraud in hospice and home health remains active enough to justify continued restriction. His remarks track with the agency’s broader fraud campaign: the fastest way to limit improper claims is often to stop questionable providers from entering the system before they can build billing histories, hide behind shell ownership, or rapidly shift operations across state lines.
The order applies nationwide, but it does not shut down existing Medicare participation. Providers already enrolled in Medicare can continue delivering services to beneficiaries. Current hospice providers and home health agencies may also add new practice locations to existing Medicare enrollments, a narrow carveout that preserves expansion for already participating entities while still limiting a fresh wave of applications. CMS also said the moratorium reaches certain changes in majority ownership, a safeguard meant to prevent bad actors from disguising control through corporate restructuring.
That ownership language matters because program abuse rarely depends on a single fraudulent claim.
In hospice and home health, fraud can move through layers of ownership, staffing arrangements, site expansion, and shifting enrollment records. The federal response is built to catch those patterns before they translate into paid claims. CMS said it will continue using advanced analytics to accelerate removal of providers likely to be perpetrating fraud, and the agency is pairing the enrollment freeze with site visits and heightened oversight in states identified as elevated-risk markets, including Arizona, California, Georgia, Ohio, Nevada and Texas.
The agency has also expanded a demonstration in Florida, Illinois, Oklahoma, Ohio, North Carolina and Texas that allows pre- and post-claim review of home health submissions. In a payment environment where claims can be processed quickly and volume can mask irregularities, those reviews create an earlier checkpoint for identifying improper billing before the dollars go out the door. CMS said recent enforcement under the broader White House fraud push has already suspended payments to 773 hospice providers and 23 home health agencies in the Los Angeles area, totaling about $70 million.
That figure gives the policy an unusually concrete edge.
Hospice and home health services are clinically essential, but they also involve vulnerable patients, recurring care coordination, and a billing structure that can be exploited if oversight is thin. Hospice fraud can be especially corrosive because it often involves patients with serious illness and families trying to navigate end-of-life care. Home health abuse can be equally harmful when it distorts medical necessity, skews access, or crowds out legitimate agencies that are trying to serve patients with complex needs.
CMS’s rationale rests on the idea that the sectors have remained attractive targets precisely because they serve people who may have limited ability to challenge questionable care patterns. By closing enrollment to new applicants for another six months, the agency is betting that fewer new corporate entities will be able to enter Medicare, establish a billing foothold, and then move on before scrutiny catches up. The moratorium is also designed to prevent suspected fraudsters from hopping state lines and resurfacing under a new enrollment record.
The National Alliance for Care at Home welcomed the administration’s scrutiny while warning about collateral pressure on access. In its response, the organization said it appreciates that providers will still be able to conduct face-to-face recertification visits via telehealth during the moratorium, a detail that could blunt some disruption for patients and families. At the same time, the group argued that CMS should direct enforcement toward high-fraud markets and clearly bad actors rather than imposing broad limits that could affect legitimate providers operating in good faith.
That tension defines the policy debate. Stronger fraud control can protect beneficiaries and taxpayers, yet sweeping enrollment restrictions can also make it harder for communities with real provider shortages to bring in new agencies. The next test will be whether CMS can keep the pressure focused on the most suspect ownership structures and billing behaviors without shrinking care access in areas already struggling to recruit hospice and home health capacity.
For now, the federal message is blunt: Medicare will keep accepting services from providers already inside the system, but it will not make it easier for new hospice and home health entrants to join while the fraud investigation remains active. The real question is how much improper billing the agency can suppress before the six-month extension expires, and whether the enforcement gains will outlast the moratorium itself.