Protecting Seniors and Stopping Fraudsters Act

Protecting Seniors and Stopping Fraudsters Act

This bill establishes additional requirements for hospice programs and home health agencies under Medicare, particularly in relation to oversight and transparency.

Specifically, the bill subjects hospice programs to revalidation within one year if the program (1) is located in a state in which new hospice programs are subject to enhanced oversight, as determined by the Centers for Medicare & Medicaid Services (CMS); and (2) has not been subject to revalidation over the previous 18 months.

Additionally, hospice programs and home health agencies that are newly enrolled, have undergone a change in ownership, or have had billing privileges reactivated must undergo surveys at least once every 12 months over the 36-month period following their change in status. The bill also requires hospice programs and home health agencies that do not submit required data to the CMS or that have an unusual rate of admissions or discharges to undergo additional surveys. The bill also subjects hospice programs and home health agencies that fail to submit required data to the CMS to larger payment reductions beginning in FY2029.

The CMS must identify hospice programs and home health agencies that are located in a state or county for which the total number of such programs and agencies significantly exceeds the totals for the previous year. The CMS must flag these programs and agencies as being at extreme risk of fraud and institute additional screening requirements, including fingerprinting requirements for certain personnel.