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There is a fine line between attacking healthcare fraud and protecting the rights of providers, including their rights to due process. CMS and Ohio’s recent focus on Medicare and Medicaid fraud in home health and hospice care may bring about great financial recoveries for the government related to bad actors. However, these initiatives could also result in a lack of due process and serious hardship for innocent providers of vital healthcare services. As such, providers should educate themselves about the new CMS and Ohio efforts and take steps to assure their businesses operate in a compliant manner.  It is no longer a matter of “whether” an agency will be audited but “when” they will be audited by CMS or the state.

Home health and hospice agencies are entering a period of materially heightened enforcement. On May 13, 2026, the Centers for Medicare & Medicaid Services (CMS) announced a six-month nationwide moratorium on new Medicare enrollment for home health agencies and hospices, along with intensified investigations, advanced data analytics, and faster removal of providers suspected of fraud. The same day, Ohio Governor Mike DeWine announced new Medicaid fraud prevention initiatives focused on home health and hospice, including a proposed statewide moratorium on new Medicaid providers in these sectors, immediate payment suspensions for providers with fraud “red flags,” more frequent revalidation of higher-risk providers, and tighter Electronic Visit Verification (EVV) controls. For agency owners and executives, the message is clear: even compliant providers should expect greater scrutiny of enrollment, ownership, documentation, visit verification, and billing patterns.

CMS’s Nationwide Crackdown: Why It Matters Now

CMS has characterized home health and hospice as high-risk categories for fraud and has shifted further toward a “stop fraud before it starts” model. According to CMS, the moratorium applies not only to new Medicare enrollment applications but also to certain changes in majority ownership that can be used to obscure control by bad actors. During the moratorium period, CMS plans to intensify targeted investigations, deploy advanced analytics, conduct nationwide hospice site visits, and accelerate removal of suspect providers from the Medicare program. CMS has also highlighted heightened oversight in several states, including Ohio, and expansion of pre- and post-claim review activity for home health claims in selected states, including Ohio. For established agencies, this means compliance risk is no longer limited to blatant misconduct; anomalies in documentation, eligibility support, face-to-face records, certifications, EVV data, or billing trends may now trigger a faster and more aggressive response from regulators.

Ohio’s New Medicaid Fraud Prevention Initiatives

Ohio’s new initiatives are especially important for agencies operating in the state because they combine preventive controls, data-driven detection, and faster administrative action. Governor DeWine announced that Ohio Medicaid will seek CMS approval for a six-month moratorium on new home health and hospice Medicaid providers; immediately remove and suspend payment to providers whose billing shows a high probability of fraud; require more frequent revalidation for higher-risk providers through emergency rulemaking; require GPS capability for providers using EVV; and begin rulemaking to require EVV use for live-in caregivers as a condition of payment. Ohio also reported that newly deployed analytics had already identified 87 providers for further review and potential payment suspension, underscoring that these initiatives are not merely prospective policy statements but are tied to active enforcement workflows. In practical terms, Ohio agencies should expect closer examination of visit authenticity, caregiver identity, service location, duration, and whether billed services align with authorizations and clinical records.[1]

7 Ways to Protect an Agency from Fraud, Waste, and Abuse

1. Maintain a living, breathing corporate compliance program. Years ago, the federal Office of Inspector General issued guidelines for corporate compliance programs. The seven core elements include (a) a written policy manual, (b) appointing a designated compliance officer, (c) conducting regular training for all team members, (d) providing secure and confidential pathways for team members to report concerns or ask questions without fear of retaliation, (e) implementing ongoing auditing and monitoring activities, (f) consistently enforcing compliance standards, and (g) taking prompt correct action whenever a violation is identified. 
2. Strengthen enrollment, ownership, and credentialing controls. Conduct enhanced due diligence on owners, managers, related entities, and changes in control, and verify that all disclosures to Medicare and Medicaid are accurate and promptly updated. CMS and Ohio are both focused on ownership transparency and provider screening, making weak governance a significant risk area.
3. Tighten clinical eligibility and documentation discipline. Require rigorous support for homebound status, skilled need, terminal prognosis, certifications, recertifications, plans of care, and visit notes. In the current environment, unsupported or cloned documentation can look like fraud even when services were actually provided.
4. Audit EVV, timekeeping, and location data aggressively. Compare EVV records, GPS/location data, schedules, payroll, authorizations, and clinical documentation to identify impossible travel, overlapping shifts, services during hospitalizations, or billing when patients were unavailable. Ohio’s new rules make EVV integrity a central fraud-prevention control.
5. Use proactive analytics and internal monitoring before the government does. Monitor outlier utilization, rapid growth, unusual diagnosis patterns, unusually long visits, high-volume caregivers, and billing spikes by branch, payer, and clinician. Ohio and CMS are openly relying on analytics, so providers should adopt the same discipline internally.
6. Build a culture of reporting, training, and rapid correction. Maintain a confidential reporting pathway, train staff and leaders regularly on fraud, waste, and abuse risks, investigate complaints promptly, refund identified overpayments when required, and document corrective action. A credible compliance program is one of the best defenses when regulators ask whether leadership exercised reasonable oversight.
7. Know your appeal and hearing rights. In the event your organization experiences an audit and demand for repayment of claims, know that you are entitled to certain due process rights, including notice of adverse action, the right to appeal and adverse determination, and the right to a hearing on the issues at hand. 

The combined federal and Ohio actions signal a sharper enforcement climate for home health and hospice agencies, especially in areas involving enrollment, ownership, documentation integrity, and visit verification. For leadership teams, the safest assumption is that regulators will expect stronger controls, faster detection of anomalies, and clearer evidence that billed services were medically necessary, properly authorized, and actually delivered. Agencies that invest now in governance, auditing, training, and documentation discipline will be better positioned to protect patient trust, preserve reimbursement, and reduce exposure to fraud, waste, and abuse investigations.

For assistance in creating a corporate compliance plan or other questions regarding how BMD can help protect your home health or hospice agency, please contact BMD Member Jeana Singleton at jmsingleton@bmdllc.com or 330-253-2001. 

[1]See, Centers for Medicare & Medicaid Services, CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice and Home Health Agency Enrollment Moratoria (May 13, 2026).  See, Governor Mike DeWine, Governor DeWine Announces New Medicaid Fraud Prevention Initiatives (May 13, 2026).  See also, Ohio Department of Medicaid, Bureau of Program Integrity.  See also, Ohio Attorney General Dave Yost, Nine Medicaid Providers Facing Fraud, Theft Charges (Apr. 17, 2026).