CMS Rushes Paperwork to Fight Medicare Home-Health Fraud
Published Date: 11/2/2026
Notice
Summary
CMS is speeding up approval to expand a program that fights fraud in California’s Medicare home health services. This quick action helps stop wasteful spending and protects patients from unnecessary care. Comments on this info collection are open until November 16, 2026, so don’t miss your chance to weigh in!
Analyzed Economic Effects
3 provisions identified: 1 benefits, 1 costs, 1 mixed.
Provider Review Choices and 25% Penalty
If you run a Home Health Agency (HHA) in demonstration states (and in California after expansion), you may choose either 100% pre-claim review or 100% post-payment review. You remain under that review method until your HHA reaches the target affirmation or claim approval rate, after which you may be relieved from reviews except for spot checks; if you do not participate in either review option, you will receive a 25 percent payment reduction on all home health claims and may be subject to Recovery Audit Contractors review.
Information Collection Burden on HHAs
CMS estimates the information collection will involve 4,700 private-sector respondents, produce 3,173,016 responses, and require 1,600,608 total annual hours. The collection frequency is 'frequently' until an HHA reaches the target rate, then 'occasionally.'
RCD Expansion to California
CMS is expanding the Review Choice Demonstration (Pre-Claim Review Demonstration for Home Health Services) to California under emergency clearance to address fraud and waste. The notice says this expansion is intended to protect Medicare Trust Funds and beneficiaries from improper payments and unnecessary home health care; comments on the information collection are open until November 16, 2026.
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