Health Law Daily Wrap Up, PROGRAM INTEGRITY—NOTICES: CMS imposes nationwide hospice and home health enrollment moratoria as part of antifraud crackdown, (May 15, 2026)

By Patricia K. Ruiz, J.D.

Sixmonth freezes aim to halt new Medicare entrants while agency expands enforcement and investigations

CMS has imposed sixmonth nationwide moratoria on the enrollment of new hospices and home health agencies (HHAs), framing the action as part of an “aggressive” federal crackdown on fraud, waste, and abuse in Medicare. The agency said the measures are designed to prevent new highrisk providers from entering the program while it intensifies investigations and enforcement against existing actors. The moratoria, effective May 13, 2026, reflect CMS’s determination that enrollment controls are necessary to address persistent program integrity risks identified in both the hospice and home health sectors. According to a press release from CMS, the moratoria will not adversely affect access to care (Notice, 91 Fed. Reg. 27954 (May 15, 2026); Notice, 91 Fed. Reg. 27946 (May 15, 2026)).

Enforcement. CMS emphasized that the moratoria are intended to stop fraud “before it starts,” preventing bad actors from obtaining Medicare billing privileges and limiting their ability to relocate geographically to avoid detection. During the sixmonth period, the agency will deploy “advanced data analytics,” intensify targeted investigations, and accelerate the removal of providers suspected of fraudulent activity.

The agency tied the action to ongoing enforcement efforts, including the suspension of payments to approximately 800 hospices and HHAs in Los Angeles associated with $1.4 billion in Medicare spending, as well as revocations and deactivations of providers engaged in improper conduct. Additional measures cited include nationwide hospice site visits, expanded pre and postclaim review demonstrations for home health claims, and enhanced enrollment screening requiring site verification and fingerprintbased background checks.

Home health. In the home health notice, CMS cited a “significant potential for fraud, waste, or abuse” based on decades of enforcement experience, lawenforcement input, and internal data analysis. The agency described HHAs as particularly vulnerable due to low startup costs and the dispersed nature of inhome services, which can limit oversight. CMS pointed to patterns such as rapid increases in provider numbers without corresponding beneficiary growth and instances of multiple HHAs operating from the same address. It also cited numerous criminal cases involving fraudulent billing schemes, including claims for services not provided and kickback arrangements for patient referrals.

Although CMS has implemented safeguards including capitalization requirements, highrisk screening classifications, and prior geographically targeted moratoria, the agency concluded these measures alone have not sufficiently mitigated risks. A nationwide moratorium, CMS stated, addresses the “migratory” nature of fraud schemes by eliminating opportunities to shift operations across jurisdictions.

Hospice. CMS described a similar but more rapidly intensifying risk profile in the hospice sector, stating that fraud, waste, and abuse concerns have grown significantly in recent years. The agency cited findings that include enrolling beneficiaries without consent, certifying patients who are not terminally ill, and billing for services that are unnecessary or never provided. CMS detailed rapid growth in hospice enrollment in several states without corresponding increases in beneficiary populations, as well as the concentration of multiple providers in limited geographic areas. CMS emphasized that these patterns, combined with documented criminal activity, indicate systemic vulnerabilities requiring preventive action. According to CMS, hospice fraud is no longer confined to traditional hotspots and has spread to additional states, reinforcing the need for a nationwide moratorium rather than a regionally targeted approach.

Legal framework, scope of moratoria. Both moratoria are issued under section 1866(j)(7) of the Social Security Act, as implemented by 42 C.F.R. § 424.570, which authorizes CMS to impose temporary enrollment freezes where necessary to combat fraud, waste, or abuse. The initial duration is six months, with the possibility of extension in sixmonth increments. The moratoria apply to initial enrollments, including new providers, branches, and practice locations, as well as certain changes in majority ownership treated as new enrollments. Applications submitted prior to May 13, 2026, are not affected. Consistent with statutory provisions, CMS’s decision to impose the moratoria is not subject to judicial review, although affected providers may administratively appeal enrollment denials limited to whether the moratorium applies to them.

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