Medicare hospice fraud bill tightens inspections and triples payment penalties

What does this do?

HR 8883 adds anti-fraud rules to Medicare's hospice and home health programs, requiring more frequent inspections of new agencies showing warning signs such as unusual billing or sudden provider spikes in one area. Providers that fail to report required quality data would face payment reductions of 15 percentage points starting in 2029, up from the current 2-4 percentage points. Administrators and medical directors in high-risk areas would be subject to tougher background checks, including fingerprinting.

Who does it affect?

Medicare beneficiaries using hospice or home health services are directly affected, as are the agencies and organizations that run those services. Accreditation organizations that certify these providers would face stricter standards and new oversight.

Why does it matter?

Some providers have been caught billing Medicare for patients who do not qualify or stealing money from the program, and the bill is designed to reduce those losses. Taxpayers who fund Medicare are also affected by the outcome, since the goal is to limit money lost to fraud.

What does it cost, and who pays?

• $100M for increased inspections
• $6M per year for patient notices