Protecting Seniors and Stopping Fraudsters Act

Key Points

• The bill sharply increases inspection frequency for hospice programs and home health agencies. Newly enrolled providers, those with ownership changes, or those that reactivated billing must be surveyed at least once every 12 months for 36 months. Providers with aberrant discharge or admission rates face surveys every 18 months.
• Medicare must notify patients in writing within 15 days of their hospice election. The notice must explain their rights in plain language, including how to revoke their election or switch hospice providers, and display the 1-800-MEDICARE phone number.
• Starting in 2029, hospice programs that fail to submit quality data will face a 15 percentage point payment reduction, up from the current 4 percentage point cut. Home health agencies face the same 15 percentage point penalty, up from 2 percentage points. A 30-day grace period exists for those making a good faith effort.
• New enrollment screening rules require fingerprinting of administrators and medical directors at hospice and home health agencies deemed at extreme risk of fraud. These providers must also show proof of comprehensive liability insurance before enrolling in Medicare.
• The bill provides $100 million from the Federal Hospital Insurance Trust Fund for fiscal year 2026 to pay for increased surveys. An additional $6 million per year starting in fiscal year 2026 is provided for patient notification letters about hospice elections.
• HHS must report annually to Congress for five years on program integrity activities, including trends in improper payments, enforcement actions taken, and the number of hospice and home health agency enrollments revoked from Medicare.