Fraud Is Local. The Freeze Is Nationwide.

About this Episode

Program integrity has become the defining fight in care at home, and one decision is landing hardest right now: a six-month, nationwide CMS moratorium on new home health and hospice enrollment.

In this episode, Alliance CEO Jennifer Sheets sits down with Patrick Harrison from the Alliance’s policy and advocacy team to unpack why a blunt national freeze is the wrong tool for a fraud problem that’s concentrated in specific markets and specific bad actors.

They draw the line between real fraud and honest mistakes, explain how fraudulent claims quietly corrupt the data CMS uses to set everyone’s rates, and walk through what the Alliance is actually telling CMS: targeted, risk-based enforcement that roots out bad actors without penalizing the compliant providers patients depend on. If you’ve ever felt punished for someone else’s bad behavior, this one’s a roadmap for pushing back, as a united industry.

What you’ll learn:

• Why a nationwide enrollment freeze misses a fraud problem that’s concentrated in specific geographies
• The real difference between fraud, waste, abuse, and a simple technical error
• How fraudulent claims corrupt the data CMS uses to set rates for legitimate providers (“bad data in, bad data out”)
• What “risk-based,” scalpel-not-sledgehammer enforcement looks like, including gold carding
• The Alliance’s message to CMS on the moratorium, and why a unified provider voice matters more than ever

Timestamps:

0:00 Cold Open & Intro
2:00 Guest Intro: Why Program Integrity Matters
3:35 Sledgehammer vs Scalpel (Bad Actors)
5:45 Fraud vs Waste vs Abuse
11:15 Alliance Track Record & CMS Work
13:55 How Fraud Impacts Rates
17:15 Key Policy Wins & Legislation
19:00 The Moratorium Explained
22:35 Access vs Enforcement Debate
23:45 What CMS Is Watching
25:45 Gold Carding & Future Solutions
29:25 What’s At Stake
31:45 Outro