The Centers for Medicare and Medicaid Services (CMS) is proposing new provider enrollment safeguards aimed at reducing fraud, waste and abuse. Although included in the Calendar Year 2027 Home Health Prospective Payment System (PPS) proposed rule, the enrollment provisions would apply across all Medicare provider and supplier types, including skilled nursing facilities (SNFs).
The proposal would expand CMS’ ability to recover improper payments by allowing the agency to recoup Medicare payments retroactive to the date of noncompliance for all provider enrollment revocations, regardless of the reason for revocation, the federal agency said in a press release. CMS estimates the changes could generate approximately $82 million in annual savings.
“These proposals would give CMS stronger tools to protect Medicare beneficiaries and taxpayer dollars from fraud, waste, and abuse,” CMS Administrator Dr. Mehmet Oz said. “The Trump Administration is committed to ensuring only qualified providers and suppliers participate in Medicare while preserving access to high-quality care for patients across the country.”
For SNFs and other Medicare providers, the impact would primarily center on enrollment compliance, including maintaining accurate Medicare enrollment information and ensuring ownership, management and operational details are properly reported. The provisions are not specifically related to SNF residents transitioning to home health services but represent a broader expansion of CMS’ Medicare program integrity efforts.
LeadingAge, the association representing more than 5,300 nonprofit and mission-driven aging services providers, is backing these efforts with some caution.
“The rule also makes several proposals related to program integrity focused on provider enrollment, personnel , and more—areas we asked CMS to focus on. We look forward to reviewing these proposals in more detail with an eye toward ensuring targeted efforts that do not overly burden legitimate providers, including our members,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement shared with Skilled Nursing News.
CMS is also proposing broader authority to deny or revoke Medicare enrollment for certain high-risk providers, including those operating in geographic areas with an excessive concentration of providers that may increase fraud risk.
“Under current regulations, certain Medicare enrollment revocations become effective prospectively — specifically, 30 days after the date that CMS or the CMS contractor mails notice of the revocation to the affected provider or supplier,” the CMS fact sheet stated. “However, other revocations take effect retroactively to the date the provider’s noncompliance began. The agency is proposing to make all revocation grounds retroactive. This action would help CMS recover monies paid to non-compliant providers and help ensure taxpayer money is paid only to legitimate, compliant providers.”
Additional enrollment actions could apply to providers or suppliers with recent misdemeanor convictions related to sexual assault or financial misconduct in the past 10 years.
“CMS currently may deny or revoke enrollment if a provider: (1) has a suspended/revoked license in another state; or (2) is suspended/revoked from Medicaid or another federal healthcare program. The agency proposes expanding this to include similar suspensions/revocations involving the provider’s owners or managing employees/organizations,” the fact sheet further noted.
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