WASHINGTON, January 16, 2026 — Dr. Mehmet Oz, administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), is leading a crackdown on widespread fraud within the home health and hospice care systems, a problem that’s costing taxpayers billions and potentially compromising patient care.
CMS Intensifies Scrutiny of Home Health, Hospice Providers
Federal officials are focusing on program integrity and enforcement to combat fraudulent activity in these vital care sectors.
- CMS officials recently met with industry stakeholders in Nevada and California to address concerns about fraud.
- Los Angeles County, California, has been identified as a hotspot for fraudulent billing practices.
- Physician involvement is a key area of focus in the investigation, with concerns about unethical practices and kickback arrangements.
- Congressional lawmakers are urging CMS to take further action to address the scams.
Oz, along with CMS Chief Operating Officer Kimberly Brant and Director for Medicare Chris Klomp, visited Nathan Adelson Hospice in Nevada before holding a roundtable discussion with representatives from LeadingAge, the National Alliance for Care at Home, the National Partnership for Healthcare & Hospice Innovation (NPHI), the California Hospice & Palliative Care Association, and approximately 15 home health and hospice providers.
“CMS was hearing about [fraud] from a lot of different sources, and decided that it was time to go see what was happening on the ground,” Mollie Gurian, vice president of policy and government affairs for LeadingAge, said.
Home health has long been a “prime target” for Medicare fraud, prompting increased actions to identify and stop suspicious activity.
What are the biggest concerns regarding Medicare home health fraud? The Medicare Payment Advisory Commission (MedPAC) recently recommended a 7% cut to Medicare home health payments, citing “program integrity concerns,” particularly in Los Angeles County, California, which has become synonymous with fraud in the home health space.
Industry stakeholders have repeatedly urged CMS to root out fraudulent practices and avoid relying on potentially inaccurate data when calculating Medicare payments.
During discussions, Oz specifically questioned stakeholders about the role of physicians in these schemes. “It’s very hard for these schemes to be successful without involving physicians, and he was very interested in what it takes today to get a physician to compromise their ethics and their schooling to go along with these schemes,” explained Hilary Loeffler, vice president of policy and regulatory affairs for the Alliance. “He was very focused on the types of kickback arrangements that are going on. He was also very interested in the scope of the problem.”
Tom Koutsoumpas, founder and CEO of NPHI, outlined several key discussion points, including:
- Observations from providers on the front lines
- The ways fraudulent and abusive behavior manifests in real-world settings
- The impact of current oversight approaches on well-performing providers
- The information CMS needs to make informed policy and enforcement decisions
- Strategies for better targeting audits and oversight toward fraudulent behaviors (such as high live discharge rates or failure to provide all levels of care)
- Avoiding unnecessary burdens on high-quality, nonprofit providers
- Leveraging provider experience to improve enforcement strategies
- Potential flaws in the current hospice benefit structure that may unintentionally encourage fraudulent activity
- Possible reforms to strengthen program integrity while maintaining access to quality care, including adjustments to eligibility, payment, and quality outcomes.
Representatives from the home health industry and CMS leaders also discussed how fraud can distort payment rates. Loeffler explained, “[CMS] does these calculations to try to figure out if they’re overpaying home health agencies under the Patient-Driven Groupings Model that they put in place, and the way they do that is they reprice claims. The issues in Los Angeles County really started surging in the past few years for home health. So if they’re trying to compare claims today and what they would have been paid in a pre-2020 scenario, there’s a bunch of what we think is sufficient billing patterns coming out of LA that we think are impacting the calculations. They’re including claims from Los Angeles County that skew their numbers.”
Oz also conducted a “ride-along” to observe areas of Los Angeles County known for fraudulent providers, many of whom operate from the same address, according to Koutsoumpas. Following the meetings, Oz announced at a press conference his commitment to crack down on fraud. Shortly after, a group of congressional lawmakers sent a letter to CMS requesting further action.
“We commend the administration for taking decisive action to confront fraud, waste and abuse in hospice care and for recognizing that strong program integrity is essential to ensuring patients and families receive the highest standard of care at one of the most vulnerable moments in their lives,” Koutsoumpas said in a statement. “By coming, putting boots on the ground to see care delivered by a trusted nonprofit provider, CMS leadership is sending a clear message that protecting quality and access is the priority.”
LeadingAge and the Alliance previously submitted recommendations to CMS outlining strategies to combat fraudulent operators.
