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CMS cracks down on Medicare fraud with sweeping new rule. The CMS has finalized a rule allowing it to deny or revoke Medicare billing privileges from providers whose parent companies or owners have violated federal healthcare rules — a first. The rule also requires home health agencies and hospices to re-enroll after major ownership changes, while boosting home health payments by 2.4% ($415M) next year.
CMS tightens Medicare enrollment rules to target ownership-level misconduct
The CMS has finalized a sweeping rule that expands its authority to revoke or deny Medicare billing privileges — not just for a provider's own violations, but also for misconduct by their parent companies or owners in other federal healthcare programs. The change, embedded in the 2027 Home Health Prospective Payment System final rule, is a direct response to the surge in private equity ownership in healthcare, which regulators say has created statutory blind spots that bad actors have exploited.
Under the new rule, home health agencies, hospices, and medical equipment suppliers must re-enroll as new Medicare providers following a majority ownership change — such as a private equity acquisition. Failure to complete re-accreditation could result in losing Medicare billing rights entirely. Enforcement actions will also now be retroactive to the date providers are notified of noncompliance.
By the Numbers
Why it matters: As private equity's footprint in healthcare grows, regulators are closing loopholes that previously shielded parent companies from accountability. This rule signals a tougher era of Medicare enrollment oversight — with real financial consequences for providers tied to bad actors up the ownership chain.
