Fighting Fraud Without Losing Access in Care at Home

About this Episode

Care at home is in one of the most consequential policy stretches in recent memory. CMS has paused new Medicare enrollment of home health and hospice providers to fight fraud, the 2027 Home Health Rule is reshaping provider economics, and Congress is deciding how to respond.

In this episode, Alliance CEO Jennifer Sheets sits down with Cam Lynch, Senior Vice President of Government and Corporate Affairs at Compassus, to talk through the current state of play and what the Alliance is advocating happen next.

Cam brings experience from the Bipartisan Policy Center, the Affordable Care Act, and Fresenius to a candid conversation about what a precise, data-driven program integrity response looks like. He and Jennifer also discuss how flawed rate-setting data shows up in real communities, and why a unified voice from the field matters more than ever.

WHAT YOU’LL LEARN

• What the CMS enrollment moratorium does and doesn’t mean for existing providers
• Why fraud enforcement should be national in intelligence but targeted in action
• What the 2027 Home Health Rule gets right and where concerns remain
• How flawed rate-setting data affects patient access on the ground
• How to make your comment letters and advocacy actually count

Timestamps:

00:00 Home Care Policy at a Crossroads: Fraud, Payment Rules, and Industry Unity
02:06 What Is an Integrated Home-Based Care Provider? Scope of Home Health, Hospice, Palliative, and Infusion Care
04:06 Why Medicare Policy and Rising Labor and Gas Costs Matter for Care at Home
06:08 How Did the CMS Moratorium Affect Providers and Patients in the Middle of Acquisitions?
08:06 Is a Nationwide Enrollment Moratorium the Right Way to Fight Fraud?
10:08 Scalpel vs. Sledgehammer: Why Program Integrity Must Be Local and Targeted
12:07 Why Home Care Is Harder Than Hospital Care: What Clinicians Face in Patients’ Homes
14:06 What Should CMS Do After the Moratorium? A Data-Driven Program Integrity Response
15:30 What the 2027 Home Health Rule Means: 2.4% Increase vs. the 3% Temporary Cut
18:08 Why Industry Unity and a Single Voice Matter When Advocating to CMS and Congress