Republican lawmakers have submitted a direct request to the Centers for Medicare and Medicaid Services (CMS) to investigate home health fraud and reevaluate the data underlying the proposed 2026 Medicare home health payment rules.
On Thursday, Congresswoman Claudia Tenney (New York) submitted a letter to CMS Administrator Dr. Mehmet Oz asking CMS to thoroughly investigate fraudulent billing practices in Los Angeles County, California. Tenney said the Medicare home health benefit is “one of the most efficient and humane parts of our nation's health care system,” and said this investigation will ensure that fraud does not distort the nation's home health benefit policy.
“I recently received alarming information documenting large-scale fraud in the Los Angeles County home health sector,” she wrote. “Specifically, this data reveals a disturbing pattern centered around physicians engaging with fraudulent home health and hospice agencies. CMS cannot continue to allow corrupted data, compounded by years of inaction under the Biden Administration, to determine future Medicare reimbursements for legitimate health care providers in my district and across America.”
The letter described a home health and hospice fraud scheme in Los Angeles County that involved one doctor billing Medicare for nearly $600 million from 2021 to 2024. The doctor reportedly billed nearly $210 million in 2024, a 124% increase from 2021.
One certifying organization will account for more than 60% of the physician-affiliated agency's total revenue in 2024, a dramatic increase from just 13% in 2019, the letter said. Tenney called any wrongdoing in the county “highly suspicious.”
The letter also outlined the cost-saving nature of home services and the dramatic reduction in access to home care in her district. Tenney wrote that the use of home health care in his district decreased by 39% from 2018 to 2024, and that in 2024, 46% of patients referred to home health care did not receive the home health care they needed.
If incorporated into the Medicare home health payment system, fraud and “distorted data” could jeopardize access to home health services, she wrote.
Tenney wrote that CMS has the authority and obligation to reevaluate data and investigate home health fraud. She encouraged CMS to consider:
– Reassessment of data informing the proposed 2026 Medicare Home Health Payment Rule and permanent adjustments to prior years
– Stop payments to providers with reliable signs of fraud
– Cancellation or denial of registration to home health and hospice organizations associated with fraudulent agencies
– Re-verify registration information for all home health and hospice providers in Los Angeles County
– Suspends new registrations in California until home health and hospice providers in Los Angeles County are recertified.
– Immediately begin a program integrity review of the fraudulent Los Angeles County doctors listed above.
“These fraudulent providers and criminal enterprises targeting Medicare are not only draining taxpayer funds, they are distorting the data that CMS utilizes to evaluate program spending and set future payment rates,” Tenney wrote. “My concern is that not fully understanding the extent of that distortion could undermine future policy decisions and negatively impact care for rural areas and aging populations in districts like mine.”
Home health care providers and stakeholders collectively protested the proposed 2026 Medicare home health payment rules. More than 952,000 public comments were submitted to the Federal Register during the public comment period. Some health care providers told Home Health Care News that if the rule passes as proposed, they would be forced to cut back on care or withdraw home health services.
