A Republican member of Congress has submitted a direct request to the Centers for Medicare and Medicaid Services (CMS) to investigate home health fraud and reevaluate the data underpinning the proposed 2026 Medicare home health payment rule.
On Thursday, Rep. Claudia Tenney, R-N.Y., submitted a letter to CMS Administrator Dr. Mehmet Oz calling for CMS to thoroughly investigate fraudulent billing practices in Los Angeles County, California. This investigation would ensure that fraud does not distort national home health payment policy, according to Tenney, who called the Medicare home health benefit “among the most efficient and humane parts of our health system.”
“I recently received alarming information documenting large-scale fraud in Los Angeles County’s home health sector,” she wrote. “Specifically, the data reveals a disturbing pattern centered around physicians who are engaged with the fraudulent home health and hospice agencies. CMS cannot continue to allow corrupted data, made worse by years of negligence under the Biden administration, to dictate future Medicare reimbursement for legitimate providers in my district and across America.”
The letter described a home health and hospice fraud scheme in Los Angeles County that involved a single physician billing nearly $600 million to Medicare between 2021 and 2024. The physician reportedly billed nearly $210 million in 2024, a 124% increase from 2021.
One accrediting organization accounted for over 60% of all revenue tied to agencies associated with this physician in 2024, according to the letter, a dramatic increase from only 13% in 2019. Tenney called the fraud in this county “highly suspicious”.
The letter also outlined the cost-saving nature of home-based services and the dramatic decline in access to in-home care in her district. Tenney wrote that home health use in her district decreased by 39% from 2018 to 2024, and that 46% of patients referred to home health did not receive needed in-home care in 2024.
If incorporated into the Medicare home health payment system, fraud and “warped data” could jeopardize access to home health services, she wrote.
Tenney wrote that CMS has both the authority and obligation to reevaluate its data and review home health fraud. She recommended CMS consider the following:
– Reevaluating the data informing the proposed 2026 Medicare home health payment rule, as well as previous years’ permanent adjustments
– Suspending payments to providers with credible fraud indicators
– Revoking or denying enrollment to home health and hospice organizations that are connected to fraudulent agencies
– Revalidating enrollment information for every home health and hospice provider in Los Angeles County
– Issuing a temporary moratorium on new enrollments in California until Los Angeles County home health and hospice providers are revalidated
– Immediately launching a program integrity review of the fraudulent physician in Los Angeles County mentioned above
“These fraudulent providers and criminal enterprises targeting Medicare not only drain taxpayer resources, they distort the data CMS relies on to evaluate program spending and set future payment rates,” Tenney wrote. “My concern is that if we don’t fully understand the extent of that distortion, it could undermine future policy decisions that could negatively impact care for rural and aging communities in districts like mine.”
Home health providers and stakeholders have protested en masse against the proposed 2026 Medicare home health payment rule. Over 952,000 public comments were submitted to the Federal Register during the public comment window. Some providers have told Home Health Care News that they would be forced to cut care or pull back on home health service lines if the rule goes through as proposed.
Click here to read an op-ed from Tenney, shared exclusively with HHCN.