Congresswoman Beth Van Duyne (R-TX) has introduced H.R.8883, the Protecting Seniors and Stopping Fraudsters Act, a sweeping Medicare program integrity bill that would significantly expand federal oversight of home health agencies and hospice programs.

The legislation comes amid growing federal scrutiny of Medicare fraud, waste, and abuse within the post-acute care sector and follows a series of recent Medicare and Medicaid program integrity initiatives advanced by the Centers for Medicare & Medicaid Services (CMS), Congress, and the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG).

The bill would increase survey frequency, tighten enrollment screening requirements, expand oversight of accreditation organizations, strengthen quality reporting enforcement, and direct additional federal resources toward identifying potentially fraudulent or aberrant provider behavior.

Importantly, many of the bill’s provisions reflect recommendations long supported by the National Alliance for Care at Home and its legacy organizations, the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO), including prior program integrity proposals.

According to the Alliance, the legislation was shaped through years of collaboration with Congress and CMS focused on targeting bad actors while minimizing unnecessary burdens on legitimate providers.

In a statement included in Congresswoman Van Duyne’s announcement, Alliance CEO Dr. Jennifer Sheets noted the organization has consistently supported targeted program integrity reforms designed to protect beneficiaries and preserve trust in the Medicare program.

Major Home Health Provisions

For Medicare-certified home health agencies, the bill would create several significant new oversight requirements.

Beginning one year after enactment, Medicare-certified home health agencies would be subject to annual standard surveys for three years if the agency:

• Is newly enrolled in Medicare
• Undergoes a change of ownership (CHOW)
• Reactivates Medicare billing privileges

The bill would also require surveys at least every 18 months for agencies that:

• Fail to submit required quality reporting data
• Display “aberrant” admission patterns or other characteristics CMS believes may indicate fraudulent or abusive behavior

However, the legislation would prohibit agencies from being subjected to more than one such survey within any 18-month period.

If enacted, these provisions would likely increase oversight intensity for newly acquired agencies, rapidly growing providers, and agencies operating in markets already viewed as high-risk by CMS.

Higher Quality Reporting Penalties

The legislation would substantially increase Medicare payment penalties tied to failure to submit required quality reporting data.

For home health agencies, the current 2% payment reduction would increase to 15% beginning in 2029.

The bill does create a limited “good faith effort” process allowing agencies up to 30 additional days to complete submissions under certain circumstances.

New “Extreme Risk of Fraud” Screening Category

The legislation would direct CMS to establish a new enrollment screening category for home health agencies and hospice programs and home health agencies considered at “extreme risk of fraud.”

Factors could include:

• Operating in geographic areas with unusually rapid provider growth
• Other CMS-designated fraud risk indicators

Enhanced screening measures could include:

• Fingerprinting administrators and medical directors
• Additional enrollment scrutiny
• Proof of comprehensive liability insurance coverage

The proposal appears targeted largely toward markets with longstanding fraud concerns, including portions of Florida, Texas, California, and Illinois.

Expanded Oversight of Accreditation Organizations

The bill would also significantly increase CMS oversight of national accreditation organizations. Under the proposal, accrediting organizations would be required to:

• Use survey standards at least as rigorous as state survey agencies
• Require CMS surveyor training for surveyors
• Undergo periodic CMS performance evaluations

CMS would additionally gain authority to impose corrective action plans, enhanced monitoring, or termination of deeming authority for accreditation organizations found to be deficient.

Hospice-Focused Provisions

A substantial portion of the legislation is directed specifically toward hospice oversight and fraud prevention initiatives.

Key hospice provisions include:

• Mandatory hospice enrollment revalidation in certain states
• Increased hospice survey frequency
• Expanded hospice quality reporting penalties
• Beneficiary notification requirements following hospice election
• Extension of hospice cap calculation adjustments through 2036

Additional Federal Funding for Enforcement

The legislation would appropriate $100 million for expanded hospice and home health survey activity and $6 million annually for hospice beneficiary election notifications.

The funding signals a potentially substantial expansion of CMS enforcement and survey infrastructure if the legislation is enacted.

Broader Federal Program Integrity Context

The bill arrives amid an increasingly aggressive federal focus on Medicare and Medicaid program integrity across the home health and hospice sectors.

Over the past several years, CMS and federal policymakers have intensified efforts involving:

• Enhanced data analytics
• Targeted provider enrollment screening
• Expanded medical review activity
• Temporary enrollment moratoria
• Increased survey activity
• Review of ownership changes and private equity transactions
• Scrutiny of billing patterns, utilization trends, and quality reporting compliance

At the same time, provider organizations have increasingly advocated for targeted enforcement against fraudulent operators while seeking to avoid broad policies that unnecessarily burden compliant providers delivering legitimate patient care.

What This Could Mean for Providers

If enacted, H.R.8883 would likely result in:

• More frequent Medicare surveys
• Increased scrutiny during enrollment and ownership changes
• Higher stakes tied to quality reporting compliance
• Expanded data-driven monitoring of provider behavior
• Greater oversight of accrediting organizations
• Increased documentation and compliance expectations

Providers operating in markets already viewed as high-risk by CMS may experience especially heightened oversight.

The legislation has been referred to the House Ways and Means and Energy & Commerce Committees and is expected to move quickly through the committee process. The Ways and Means Committee is reportedly expected to mark up the bill this week.

HCAF will continue monitoring the legislation and evaluating its potential operational and compliance implications for Florida home health providers.