Protecting Seniors and Stopping Fraudsters Act

Where Medicare already fingerprints high-risk applicants, a hospice or home health agency in a fraud-risk area would also have to fingerprint its administrator and its medical director. The bill would not add fingerprinting where none applies today.

Today a hospice that skips required quality reports loses 4 percentage points of its yearly Medicare rate update. Starting in fiscal year 2029 the cut would be 15 points, which is more than a typical yearly raise, so its pay would fall.

A home health agency that does not send in required quality data now loses 2 percentage points of its yearly rate update. From 2029 the cut would be 15 points, though an agency that tried in good faith could get up to 30 extra days to file.

Medicare limits what it pays each hospice per year, and a hospice must repay anything above that limit. A slower-growing formula sets that limit today, and the switch back to the older, higher formula would move from 2035 to 2036, so more hospices would owe money back.

Where the number of hospices or home health agencies in a state or county jumped in the past year, new applicants there would be treated as at extreme risk of fraud. They would have to show proof of a full liability insurance policy before Medicare let them bill.

Medicare, not the hospice, would send the notice. It would list the hospice's name, address and phone number, explain in plain language the coverage the person gave up, and say how to cancel or switch hospices.

Today every hospice is checked at least once every 36 months. The bill would add a check every 12 months for three years after a hospice enrolls, changes owners or restarts billing, plus a check within 18 months for a hospice whose rate of patients leaving alive looks unusual.

Today Medicare may inspect a home health agency within two months of an ownership change, but does not have to. The bill would require a check every 12 months for three years, and a check within 18 months for an agency whose rate of new patients looks unusual.

Medicare already puts new hospices in some states under extra watch; six states are covered today. In those states Medicare would have to re-verify the Medicare sign-up of every established hospice not re-verified in the past 18 months, within one year.

Some hospices and home health agencies are inspected by private accrediting groups rather than by state agencies. The bill would set training and survey standards for those groups and let Medicare pull their approval; existing approvals would lapse one year after enactment unless Medicare confirmed them first.