Volume 26.06
Effective today, May 13, 2026, the U.S. Centers for Medicare & Medicaid Services (“CMS”) has issued a Notice and imposed a national six (6) month moratorium on the Medicare enrollment of hospices.
Beginning on May 13, 2026, no new hospices will be enrolled into Medicare unless the hospice’s enrollment application was received by the applicable Medicare contractor prior to May 13, 2026. It is noteworthy that the moratorium can be extended for additional six (6) month increments at the discretion of CMS.
In determining whether to establish an enrollment moratorium, CMS considered whether a high risk of fraud, waste, or abuse exists. CMS also relies on its own and law enforcement’s longstanding experience with ongoing and emerging fraud trends and activities gained through civil, criminal, and administrative investigations and prosecutions.
CMS, in the Notice, noted the following:
· Instances of hospices certifying patients for hospice care when they were not terminally ill and providing little to no services to beneficiaries. This included telling patients that they were terminally ill when they were not. In such circumstances, beneficiaries who are inappropriately deemed terminally ill may be denied coverage for other care because they are receiving the hospice benefit.
· The rapid growth in potentially fraudulent hospices, particularly in Arizona, California, Nevada, and Texas, and that some of the addresses for these hospices appeared to be non operational.
· “Churn and burn” schemes whereby a new hospice opens and starts billing but once that hospice is audited or reaches its statutory yearly payment limit, it shuts down, keeps the money, and buys a new Medicare billing number; it then transfers its patients over to the new Medicare billing number, and starts billing again.
The moratorium does not apply to:
· Changes in practice location, except the addition of a new location,
· Change in provider or supplier information on file,
· Change in ownership except those which would require the submission of an initial enrollment, and
· Any enrollment received by the Medicare contractor prior to May 13, 2026.
A provider or supplier that is impacted by a moratorium may use the existing appeal procedures at 42 CFR part 498 to administratively appeal a denial of billing privileges based on the imposition of a temporary moratorium. The scope of any such appeal, though, would be limited solely to assessing whether the temporary moratorium applies to the provider or supplier appealing the denial.
The Notice is available here.
Further information will be provided regarding the moratorium and its implementation. Do not hesitate to contact us at contact@healthgroup.com with your questions regarding this matter.