Building on the Alliance’s longstanding advocacy for targeted, effective program integrity
(Alexandria, VA and Washington, DC) -The National Alliance for Care at Home (the Alliance) supports 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. At the same time, the testimony today made it clear that Medicare, Medicaid, and home care services are not anomalies in the health care space. Fraudsters seek to exploit vulnerabilities in every healthcare program and payment source due to the substantial resources spent on health services, and home care services are no different. We encourage Congress to approach crushing fraud in collaboration with the Alliance and our members as we are committed to rooting out bad actors in our space to preserve services for those who need them most.
The Alliance has been actively engaged on these issues and, in late 2025, submitted detailed recommendations to CMS outlining data-driven, risk-based strategies to strengthen program integrity in Medicare home health and hospice. Those recommendations focused on targeting bad actors while preserving access to care and minimizing unnecessary burden for compliant providers. This 2025 letter builds on years of active advocacy from the Alliance and its legacy organizations, beginning in 2019, to ensure that the ideals at the heart of these care models are upheld in the practice of care.
Similarly, the Alliance collaborates with our members and state-level organizations to strengthen service delivery at the state level. We believe that there are opportunities to strengthen fraud mitigation activities within Medicaid programs. We are proactively developing recommendations to address fraud in Medicaid-funded home care services and look forward to collaborating with Congress and the Administration to implement these safeguards.
As policymakers consider next steps following today’s hearing, it is critical that oversight strategies remain focused on risk-based enforcement—identifying and removing fraudulent entities without undermining legitimate providers delivering high-quality care in the home. We also believe that it is essential to highlight the distinction between legitimate home and community-based services (HCBS) and fraudulent activity, the value of these services and supports, and the reasons why it is appropriate to pay for this care. For example, some of the discussions and lines of questioning broadly framed personal care and self-directed services in a negative light. It is important to remember that these services are crucial components of promoting health, safety, and community integration for older adults and people with disabilities. The Administration and Congress must carefully craft responses that target fraud and do not negatively impact legitimate providers of care or access to services. Home-based care plays a vital role in improving outcomes, reducing hospitalizations, and supporting individual choice. Any program integrity reforms should protect access to these services for the individuals and families who rely on them.
The Alliance stands ready to serve as a resource to policymakers as these discussions continue and is committed to collaborating on solutions that strengthen accountability while maintaining access to care at home.
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About the National Alliance for Care at Home
The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org.
Press Contact
communications@allianceforcareathome.org
Hannah Kristan | 202-355-1647