Program Integrity

The Alliance is committed to strong, targeted efforts to prevent fraud, waste, and abuse across federal healthcare programs. Program integrity is essential to protecting patients, taxpayers, and the sustainability of Medicare and Medicaid.

Any fraudulent activity in home health, hospice, or home and community-based services (HCBS) is a threat to patients and legitimate providers who are operating in good faith in an increasingly challenging landscape. The Alliance has always worked closely with lawmakers and regulators, and with the care at home community, to ensure the ideals at the heart of these care models are upheld in the practice of care.

Care at home providers put patients’ values, wishes, and goals first, creating a plan of care to support each patient and family. For providers to continue to deliver on this promise, we need policies and regulations in place to ensure:

• Oversight strategies remain focused on risk-based enforcement – identifying and removing fraudulent entities without undermining legitimate providers delivering high-quality care in the home
• Deterrence strategies are in place to ensure bad actors are not able to enter the care at home space
• Local, state, and federal agencies have the capacity to set and enforce licensure and certification requirements
• Patients and their families understand their benefits and have access to the quality care they deserve
• Providers strive to deliver above and beyond the requirements of Medicare and Medicaid

This approach is core to the Alliance’s advocacy efforts. We know that for care at home to continue to exist, providers must stay true to their core values, so we protect those values, work to eliminate bad actors, and support the delivery of the highest quality of care.

As Alliance members continue to take an active role in program integrity initiatives and conversations, members are encouraged to visit the Program Integrity Alliance Member Resource page to stay prepared, engaged, and informed.

Recommendations from the Alliance

On March 30, the National Alliance for Care at Home (the Alliance) submitted a letter to Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), regarding the Request for Information related to Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH).

The Alliance, LeadingAge, LeadingAge California, and the California Association for Health Services at Home (CAHSAH) in a March 25, 2026 letter to CMS commend the agency’s actions to protect Medicare beneficiaries, preserve the integrity of the hospice and home health benefits, and root out bad actors who are exploiting the program and harming patients and families. At the same time, the associations emphasized the need for a carefully targeted federal response to protect current and prospective patients, and preserve access to care delivered by trustworthy providers.

In late 2025, the Alliance submitted detailed recommendations to CMS outlining data-driven, risk-based strategies to strengthen program integrity in Medicare home health and hospice.  

In early 2026, the Alliance submitted a comprehensive set of program integrity recommendations to CMS Administrator Dr. Oz in response to increasing concerns around the country regarding instances of fraud in Medicaid funded services.

The Alliance – and its preceding legacy organizations – have been advocating for program integrity since 2019. Notably for hospice care, in 2022, the organizations worked collaboratively to develop and vet a detailed list of 34 program integrity recommendations, which built on provisions of the HOSPICE Act that were already being implemented. Since then, over half of the measures have been implemented, but the Alliance carries forward this important work as more measures are needed to protect the patients and families who depend on quality care and the legitimate providers who deliver it.