Why Providers Are Pushing Back Against the Moratorium

The moratorium, announced as part of CMS’s broader effort to combat fraud, waste, and abuse in Medicare programs, has left many providers scrambling to adjust their business plans. While the agency argues the measure is necessary to prevent fraudulent actors from exploiting loopholes, critics say it fails to distinguish between legitimate providers and subpar actors.

Dean Alverson, president and CEO of LifeCare Home Health Family, which operates in Texas, Florida, Nevada, and Arizona, acknowledged the need to address fraud but questioned the moratorium’s effectiveness. “The moratorium will impact our organization’s plans for growth and may affect broader operations,” Alverson said in an email. “We have been successfully expanding access to care through a de novo strategy, particularly in underserved and high-demand markets. Under the current moratorium, that approach will no longer be available, limiting our ability to respond to growing patient needs.”

LifeCare Home Health, which serves over 100,000 patients annually through seven brands, has been a vocal advocate for expanding access to care in underserved communities. The moratorium, Alverson argued, will force the company to shift its focus away from growth and toward maintaining existing operations—a move that could exacerbate shortages in areas already struggling with limited provider capacity.

Rexanne Domico, president and CEO of Interim HealthCare, echoed these concerns, noting that franchise-based providers like hers will feel the brunt of the moratorium’s impact. “We are a franchise network, and our local franchise partners serve their communities—places where they live, work, and know care is needed,” Domico said. “These types of providers will feel the pain of this overreaching decision more than larger national providers.”

Interim HealthCare, based in Sunrise, Florida, operates over 300 care centers across the U.S., offering home health, hospice, palliative, and pediatric care. The company’s franchise model relies on local providers expanding within their communities, a strategy now threatened by the moratorium.

Who Will Feel the Brunt of the Moratorium?

The moratorium’s most significant impact will likely be felt in rural and underserved areas, where access to home health and hospice services is already limited. Hillary Loeffler, vice president of policy and regulatory affairs at the National Alliance for Care at Home (the Alliance), warned that the ban on new enrollments will disproportionately affect these communities.

“The moratorium does still allow for changes of ownership, but its move to prohibit providers from entering new geographies will most impact rural and underserved areas that do not currently have sufficient access to care,” Loeffler said. “This is particularly concerning given the growing demand for home health services among an aging population.”

While CMS has framed the moratorium as a tool to prevent fraudulent providers from relocating across state lines, Loeffler questioned the agency’s justification. “There’s not enough justification in CMS’s notice as to why they think this fraud problem is nationwide,” she said. “They declare that This proves, but they really haven’t presented sufficient information to justify taking such a broad brush approach.”

How CMS Justifies the Moratorium—and Why Critics Disagree

CMS has stated that the moratorium is part of a broader crackdown on fraud in home health and hospice care, two sectors that have seen significant scrutiny in recent years. The agency plans to use advanced data analytics, artificial intelligence, and expedited investigations to identify and remove suspected fraudulent providers during the six-month period.

Michelle Huntsman, a partner at Holland & Knight’s Houston health care law team, noted that the moratorium signals a shift toward stricter enforcement in the healthcare market. “We will continue to see investigations, congressional hearings, and scrutiny of hospice and home health across the entire country,” Huntsman said. “This is part of a broader federal push to hold providers accountable for compliance.”

However, Huntsman also warned that the moratorium will create additional challenges for providers seeking to expand or undergo ownership changes. “Buyers need to be doing additional diligence and make sure they fully understand any prior changes of ownership that the target has undergone,” she said. “Transactions and change-of-ownership reviews will be under closer scrutiny, and processing times will likely unhurried across the board.”

Providers are now advising their teams to maintain rigorous compliance cultures, review billing and coding practices, and consult with legal counsel to navigate the moratorium’s complexities. Huntsman emphasized that while the moratorium may be well-intentioned, its implementation risks harming legitimate providers who are already operating within regulatory guidelines.

A Historical Precedent: The 2013 Moratorium and Its Aftermath

The current moratorium is not the first time CMS has imposed such restrictions. A similar ban was enacted in 2013 and extended multiple times before finally expiring in 2019. Huntsman suggested that history may repeat itself, with the new moratorium facing potential extensions beyond its initial six-month period.

“It is somewhat likely that this moratorium will be extended,” Huntsman said. “Given the tools CMS now has—including AI-driven analytics and enhanced oversight—there may be little incentive to lift the ban unless clear progress is demonstrated.”

Loeffler shared these concerns, noting that CMS has not provided any clear benchmarks or goalposts for when the moratorium might be lifted. “They have the tools to target fraudulent actors effectively, but this moratorium worries us because it lacks transparency,” she said. “What will it take to lift this moratorium? There’s no clear bar that CMS has provided publicly.”

What’s Next for Home Health and Hospice Providers?

As the moratorium takes effect, providers are left grappling with uncertainty about its duration and impact. While CMS has committed to using the six-month period to intensify fraud investigations, many in the industry fear the moratorium will do more harm than good by limiting access to care for patients who rely on home health and hospice services.

For now, providers are focusing on compliance, transparency, and maintaining strong relationships with patients and communities. Alverson of LifeCare Home Health urged CMS to reconsider the moratorium’s approach, suggesting that targeted enforcement—rather than a blanket ban—would be more effective in addressing fraud without sacrificing access to care.

“We support CMS’s efforts to curb fraud, but this moratorium is not the right tool for the job,” Alverson said. “Instead of limiting growth, CMS should focus on deploying the tools it already has—like AI and data analytics—to identify and remove bad actors while allowing compliant providers to continue serving their communities.”

Where to Find Official Updates

For the latest information on CMS’s moratorium and its impact on home health and hospice providers, readers can monitor the following sources:

• Centers for Medicare & Medicaid Services (CMS) Official Website
• Medicare.gov for updates on home health and hospice services
• Office of Inspector General (OIG) Reports on healthcare fraud investigations
• National Alliance for Care at Home (the Alliance) for industry advocacy updates

Call to Action

As the home health and hospice communities navigate this uncertain period, your voice matters. If you or a loved one rely on these essential services, share your experiences in the comments below. How has the moratorium affected access to care in your community? What steps should CMS take to balance fraud prevention with patient access?

Stay informed, stay engaged, and let’s ensure that policies like this one prioritize both integrity and compassion in healthcare.