Protecting Seniors and Stopping Fraudsters Act
- Sponsor
- Rep. Van Duyne, Beth [R-TX-24]
- Committees
- Ways and Means Committee (primary)
- Last action
- May 21, 2026
Bottom line
This bill aims to combat Medicare fraud and improve the quality of care in hospice and home health services through stricter oversight, increased accountability, and enhanced beneficiary information.
What it actually does
This bill amends the Social Security Act to significantly enhance oversight of hospice programs and home health agencies under the Medicare program. It mandates revalidation of existing hospice enrollments in states where new hospices face enhanced scrutiny, increases the frequency of surveys for certain high-risk hospice programs and home health agencies, and strengthens enrollment screening for providers deemed at extreme risk of fraud. Additionally, it raises payment penalties for failing to submit quality data, extends a hospice cap calculation adjustment, and requires CMS to provide written notice to beneficiaries regarding their hospice election.
Proponents argue
Proponents argue that the bill is crucial for protecting vulnerable seniors from fraudulent practices in hospice and home health care, ensuring that Medicare funds are used appropriately, and improving the quality of care by holding providers to higher standards. They would emphasize the need for increased scrutiny in areas prone to fraud and the importance of timely and accurate quality data submission to inform patient choice and policy.
Opponents contend
Opponents might argue that the increased administrative burden and stricter regulations, particularly the enhanced survey frequencies and higher payment penalties, could disproportionately affect legitimate, smaller, or rural hospice and home health providers. They contend this could lead to financial distress, potential closures, and ultimately limit access to essential care for beneficiaries, especially in underserved areas.
The bill is moderately complex due to its technical amendments to existing law and specific Medicare program details, but its length allows for a thorough reading within a reasonable timeframe for stakeholders.
Section 2(a), amending Section 1866(j) of the Social Security Act
Mandatory Revalidation of Hospice Enrollment in High-Oversight States
If the Secretary of Health and Human Services (HHS) implements enhanced oversight for new hospice programs in a particular state due to fraud concerns, this provision requires the Secretary to revalidate the Medicare enrollment of all existing hospice programs in that state within one year. This applies to programs that have not undergone revalidation in the preceding 18 months, aiming to ensure comprehensive scrutiny beyond just new entrants.
Supporters argue
Supporters argue this provision closes a loophole by ensuring that existing fraudulent operations are also identified and removed, not just new ones, thereby protecting Medicare funds and vulnerable beneficiaries from exploitation.
Critics contend
Critics might argue this could create an excessive administrative burden on established, compliant hospice programs, especially if the 'enhanced oversight' trigger is broadly applied, potentially leading to unnecessary disruptions in care delivery.
Tradeoffs
This provision balances the need for robust fraud prevention and program integrity with the potential for increased administrative burden on legitimate hospice providers.
Section 3(a), amending Section 1822(a)(1) of the Social Security Act
Enhanced Survey Frequency for High-Risk Hospice Programs
Beginning one year after enactment, hospice programs that are newly enrolled in Medicare, have undergone a change of ownership, or have reactivated billing privileges will be subject to a survey at least once every 12 months for a three-year period. Additionally, hospices failing to submit quality data or exhibiting 'aberrant behavior' (e.g., high live discharge rates) will be surveyed within 18 months of their last survey, with a limit of one such survey per 18-month period.
Section 3(b), amending Section 1814(i)(5) of the Social Security Act
Increased Payment Penalty for Non-Submission of Hospice Quality Data
For fiscal year 2029 and subsequent years, the payment reduction for hospice programs that fail to submit required quality data to the Secretary will increase significantly from 4 percentage points to 15 percentage points. The Secretary is also required to establish a process allowing a 30-day extension for hospices demonstrating a good faith effort to submit their data.
Section 4(a), amending Section 1891(c)(2)(B) of the Social Security Act
Enhanced Survey Frequency for High-Risk Home Health Agencies
Similar to the provisions for hospices, beginning one year after enactment, home health agencies that are newly enrolled in Medicare, have undergone a change of ownership, or have reactivated billing privileges will be surveyed annually for a three-year period. Additionally, agencies failing to submit quality data or exhibiting 'aberrant behavior' (e.g., high beneficiary admission rates) will be surveyed within 18 months of their last survey, with a limit of one such survey per 18-month period.
Section 4(b), amending Section 1895(b)(3)(B)(v) of the Social Security Act
Increased Payment Penalty for Non-Submission of Home Health Quality Data
For 2029 and subsequent years, the payment reduction for home health agencies that fail to submit required quality data will increase from 2 percentage points to 15 percentage points. The Secretary must also establish a process for granting a 30-day extension for agencies that demonstrate a good faith effort to submit their data.
Section 5, amending Section 1866(j)(2) of the Social Security Act
Enhanced Enrollment Screening for High-Fraud-Risk Hospice and Home Health Agencies
Beginning one year after enactment, hospice programs and home health agencies applying for Medicare enrollment that are determined to be at an 'extreme risk of fraud' will face additional screening requirements. These include mandatory fingerprinting for the administrator and medical director (if fingerprinting is generally required for such providers) and a requirement to obtain comprehensive liability insurance. 'Extreme risk' is defined, in part, by being located in a state or county with a significant increase in the number of such providers in the preceding year.
Section 6, amending Section 1865 of the Social Security Act
Stricter Standards for Accreditation Bodies
Beginning one year after enactment, national accreditation bodies seeking Medicare approval must demonstrate that their survey procedures meet or exceed state agency standards and require their surveyors to complete relevant basic training courses offered by the Centers for Medicare & Medicaid Services (CMS). Existing approvals will be reviewed against these new standards. The Secretary must also establish a mechanism to periodically assess the performance of accreditation bodies and impose remedies for deficiencies, including corrective action plans or termination of approval.
Section 8(a), amending Section 1812(d)(2) of the Social Security Act
Mandatory Beneficiary Notice of Hospice Election
For hospice elections made on or after one year after the bill's enactment, the Secretary must provide written notice to the individual within 15 calendar days of the election's effective date. This notice must include the hospice program's name, address, and phone number, a plain language description of the waiver of rights associated with hospice election, and an explanation of how to revoke or change the election, along with the 1-800-MEDICARE number.
Section 9
Annual Report on Hospice and Home Health Program Integrity Activities
The Secretary of HHS is required to submit an annual report to the appropriate committees of Congress for five years, starting one year after enactment. This report will detail the outcomes of program integrity activities conducted with respect to hospice and home health agencies, including the types of entities conducting reviews, the number of activities performed, identified trends (e.g., high rates of ineligible certifications), findings, enforcement actions taken (including revocations), and actions taken to reduce duplication of efforts and administrative burden.
This subsection provides dedicated funding for the new requirement to send written notices to Medicare beneficiaries regarding their hospice election. It mandates the transfer of $6,000,000 annually from the Federal Hospital Insurance Trust Fund to the CMS Program Management Account, starting in fiscal year 2026, with funds remaining available until expended.
Section 8(b), adding new subsection 1812(h) to the Social Security Act
Why it matters:This is standard legislative practice for providing specific, ongoing funding for a new administrative mandate, ensuring that the implementing agency has the necessary resources without requiring annual appropriations battles for this particular item.
Case for: Supporters would argue that this dedicated funding ensures the new beneficiary notification requirement is adequately resourced, preventing it from becoming an unfunded mandate on CMS and guaranteeing timely and effective implementation of this important beneficiary protection.
Case against: No specific opposition is typically raised against funding for beneficiary notices, but some might raise broader concerns about the specific amount or the source of funds if they have overarching concerns about the solvency of the Hospital Insurance Trust Fund.
Estimated impact: $6 million annually from fiscal year 2026 onwards.
This section provides significant funding for the increased survey frequencies for hospice programs and home health agencies mandated in Sections 3(a) and 4(a). It directs the transfer of $100,000,000 from the Federal Hospital Insurance Trust Fund to the CMS Program Management Account for fiscal year 2026, with funds remaining available until expended. This transfer is in addition to other existing transfers.
Section 10
Why it matters:This is standard legislative practice for providing specific, one-time (or time-limited) funding for new or enhanced activities, ensuring that the implementing agency has the necessary resources for a significant program expansion.
Case for: Supporters would argue that this funding is essential to enable CMS and state survey agencies to effectively implement the significantly increased survey requirements, ensuring that the enhanced oversight can be carried out to combat fraud and improve quality of care.
Case against: Some might argue about the scale of the funding or the source, particularly if they have concerns about the overall solvency of the Federal Hospital Insurance Trust Fund, or if they believe the mandated survey increases are excessive and may not yield proportional benefits.
Estimated impact: $100 million for fiscal year 2026.