The U.S. Centers for Medicare & Medicaid Services (CMS) should investigate home health and hospice fraud and reconsider the data behind the agency’s determination of home health payment rates.

On Thursday, Rep. Claudia Tenney (R-N.Y.) submitted a letter to CMS Administrator Dr. Mehmet Oz calling for CMS to thoroughly investigate fraudulent billing practices in Los Angeles County, California. This investigation would ensure that fraud does not distort national home health payment policy, according to Tenney, who called the Medicare home health benefit “among the most efficient and humane parts of our health system.”

“I recently received alarming information documenting large-scale fraud in Los Angeles County’s home health sector,” she wrote. “Specifically, the data reveals a disturbing pattern centered around physicians who are engaged with the fraudulent home health and hospice agencies. CMS cannot continue to allow corrupted data, made worse by years of negligence under the Biden administration, to dictate future Medicare reimbursement for legitimate providers in my district and across America.”

Los Angeles County has been reportedly rife with hospice fraud, according to many sources. A rash of hospice scams perpetrated by hundreds of mostly new providers have been occurring with a concentration in four states, California, Arizona, Texas and Nevada. These operators have accepted or paid kickbacks for referrals, enrolled patients who were not terminally ill and have provided poor care or in some cases none at all.

The letter described a home health and hospice fraud scheme in Los Angeles County that involved a single physician billing nearly $600 million to Medicare between 2021 and 2024. The physician billed nearly $210 million in 2024, a 124% increase from 2021.

The letter also outlined the cost-saving nature of home-based services and the dramatic decline in access to in-home care in her district.

It also honed in on the proposed 2026 home health payment rule. If incorporated into the Medicare home health payment system, fraud and “warped data” could jeopardize access to home health services, she wrote.

Home health providers and stakeholders have protested en masse against the proposed 2026 Medicare home health payment rule. More than 952,000 public comments were submitted to CMS during the public comment window.

Tenney wrote that CMS has both the authority and obligation to reevaluate its data and review home health and hospice fraud. She recommended CMS consider the following:

• Reevaluating the data informing the proposed 2026 Medicare home health payment rule, as well as previous years’ permanent adjustments
• Suspending payments to providers with credible fraud indicators
• Revoking or denying enrollment to home health and hospice organizations that are connected to fraudulent agencies
• Revalidating enrollment information for every home health and hospice provider in Los Angeles County
• Issuing a temporary moratorium on new enrollments in California until Los Angeles County home health and hospice providers are revalidated
• Immediately launching a program integrity review of the fraudulent physician in Los Angeles County mentioned above

“These fraudulent providers and criminal enterprises targeting Medicare not only drain taxpayer resources, they distort the data CMS relies on to evaluate program spending and set future payment rates,” Tenney wrote. “My concern is that if we don’t fully understand the extent of that distortion, it could undermine future policy decisions that could negatively impact care for rural and aging communities in districts like mine.”

Home Health Care News Associate Editor Morgan Gonzales contributed to this report.