[Congressional Record Volume 172, Number 128 (Wednesday, August 5, 2026)]
[Senate]
[Pages S4477-S4478]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS:
  S. 5250. A bill to amend title XVIII of the Social Security Act to 
decrease fraud related to home health agencies in Medicare, and for 
other purposes; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I rise today to introduce the Medicare 
Home Health Payment Integrity and Protection Act. This legislation 
would strengthen the Medicare home health program by advancing two 
complementary goals: protecting the home health program from fraud and 
strengthening access to these important services for the Americans who 
need them.
  I have long been a strong supporter of home healthcare. In a home 
visit I made in one of my first years as a Senator, I saw firsthand the 
extraordinary difference that skilled nurses, therapists, and other 
home health professionals make in the lives of patients and their 
families. Every day, these dedicated caregivers enable millions of our 
Nation's most frail and vulnerable individuals to remain in the 
comfort, security, and privacy of their home, which is where they most 
want to be.
  Home healthcare not only improves patients' quality of life but also 
helps avoid unnecessary hospitalizations and nursing home admissions, 
producing substantial savings for Medicare, Medicaid, and families 
alike.
  For these reasons, we should be strengthening, not weakening, the 
Medicare home health program.
  Yet recent trends present a troubling paradox. Despite the rapid 
aging of our population, the number of traditional Medicare 
beneficiaries receiving home health services has declined in recent 
years, from approximately 3.3 million beneficiaries in 2019 to 2.7 
million just 5 years later.
  At the same time, nearly everywhere in our country, the number of 
Medicare-certified home health agencies has also been dropping. 
According to the most recent report of MedPAC, which is the independent 
agency analyzing and advising Congress on Medicare, excluding 
California, more than 500 home health agencies closed between 2019 and 
2024, a decline of 5 percent.
  The picture is dramatically different in California, however, where 
the number of Medicare home health agencies has doubled over the same 
time period. Nearly all of that growth has occurred in Los Angeles 
County.
  If that strikes you as strange, you are in good company. As MedPAC 
observed, many stakeholders, including the California State Auditor, 
have concluded that the unusual pattern of home health agency growth 
and use in Los Angeles County raises ``significant program integrity 
concerns.''
  In plain language, that means fraud.
  MedPAC further noted that Los Angeles County has already been 
identified as a major hotspot for waste, fraud, and abuse in Medicare 
hospice services and that the dramatic increase in home health agencies 
in the same area raises further flags. The California State auditor 
reported that one office building housed the corporate offices of more 
than 100 hospice agencies and dozens of home health agencies--a 
striking example of how organized fraud can exploit weaknesses in 
Medicare hospice enrollment and oversight.
  The concentration of Medicare home health spending in Los Angeles 
County is its own issue. This can be seen by the lopsided spending 
generated there. Even though only 2 percent of the Nation's Medicare 
fee-for-service beneficiaries live in Los Angeles County, that 2 
percent generates 9 percent of all Medicare fee-for-service home health 
expenditures in the entire Nation--roughly 4\1/2\ times the expected 
share.
  CMS is fully aware of the fraud problem in Los Angeles County and has 
responded aggressively. I commend the Agency for doing so. My 
legislation builds on those efforts by strengthening CMS's ability to 
stop fraudulent providers before they enter the Medicare Program, 
ending the ``pay and chase'' model.
  The bill accomplishes this goal by enhancing enrollment screening for 
owners and managers of agencies operating in objectively high-risk 
markets, requiring more rigorous oversight of new and high-risk 
providers through targeted surveys, strengthening oversight of 
accrediting organizations, and improving verification that Medicare 
beneficiaries actually received the services billed to the program. 
Further, the bill requires agencies in high-risk areas to provide 
documentation showing that they are legitimate businesses, such as 
proof of liability insurance. The bill also requires more frequent 
unannounced site visits for agencies that are new, have changed 
ownership, or are reactivating their billing privileges. Funding to 
support these efforts is also authorized. These reforms are designed to 
identify fraudulent providers early while allowing legitimate agencies 
to focus on delivering quality patient care.
  The consequences of fraud extend well beyond the communities in which 
it occurs. When billions of dollars are improperly siphoned from the 
Medicare home health program, the result can undermine the integrity of 
the payment system used to reimburse legitimate providers. Honest home 
health agencies--particularly those serving rural communities--already 
face rising labor costs, workforce shortages, and the challenges of 
providing care across large geographic areas. Inadequate reimbursement 
threatens their ability to continue serving the seniors who depend upon 
them.
  Protecting the integrity of the Medicare home health program 
therefore requires more than identifying and prosecuting fraud; it also 
requires ensuring that legitimate providers are reimbursed fairly for 
the medically necessary care they provide.

[[Page S4478]]

  This is the bill's second key objective. To accomplish this, my bill 
directs CMS to reset the home health base payment amount using 2020 
rates, adjusted for inflation, before applying future payment updates. 
Resetting to 2020 is appropriate because it reflects the first year of 
the current payment methodology under the Patient-Driven Groupings 
Model and predates the fraud patterns that later emerged. The bill also 
addresses a calculation distortion in the current payment methodology 
and directs CMS to implement appropriate corrections going forward.
  This legislation strikes the right balance. It strengthens CMS's 
ability to prevent fraud before taxpayer dollars are lost, while 
ensuring that honest providers have the resources necessary to continue 
delivering high-quality care. It advances both program integrity and 
payment integrity, protects Medicare beneficiaries, safeguards taxpayer 
dollars, and helps preserve access to the home health services that 
allow millions of Americans to receive care safely and independently in 
their own homes.
  I want to note that these program integrity provisions align with 
those outlined in the Protecting Seniors and Stopping Fraudsters Act, 
introduced by Rep. Van Duyne in May. I look forward to working with her 
to move our bills forward as quickly as possible.
  I urge my colleagues to join me in supporting this important 
legislation.
                                 ______