CMS Enforcement Plan Raises the Stakes for Compliance Readiness

CMS Enforcement Plan Raises the Stakes for Compliance Readiness

The Centers for Medicare & Medicaid Services (CMS) proposed new rules this month that would make it easier to revoke a provider's Medicare enrollment and extend the window regulators have to claw back past payments. The proposal is part of the 2027 Home Health payment rule and applies across provider and supplier types.

One provision stands out for long-term care, skilled nursing facilities, home health, and hospice operators: CMS wants the authority to revoke providers' enrollment in geographic areas flagged as high risk for fraud, which is the same approach recently used to suspend 447 hospices and 23 home health agencies in the Los Angeles area.

Extended clawback periods mean documentation gaps from years past can resurface. Compliance readiness isn't just about what's happening today. It's about whether the paper trail holds up under scrutiny.

"These proposals would give CMS stronger tools to protect Medicare beneficiaries and taxpayer dollars from fraud, waste, and abuse." — Mehmet Oz, CMS Administrator

Regulatory pressure is only increasing. CHUG members know that staying ahead of enforcement trends starts with staying prepared.

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