Medicare Home Health Payment Integrity and Protection Act of 2026

Reduced Medicare Fraud: By implementing enhanced enrollment screening for agencies at extreme risk of fraud, such as requiring fingerprinting for administrators and proof of liability insurance, the bill seeks to decrease fraudulent activity (Section 101).

Increased Oversight of Care Providers: The bill requires more frequent standard surveys (every 12 months for 36 months) for newly enrolled agencies or those with ownership changes, and more frequent surveys for those with aberrant admission rates or missing quality data (Section 102).

Better Quality Standards for Accreditation: National accreditation bodies must now meet or exceed state and local survey standards and require surveyors to complete basic training from the Centers for Medicare & Medicaid Services (Section 103).

Protection for Legitimate Providers: The Secretary will exclude "suspect claims" (data from providers suspected of fraud, waste, or abuse) when calculating payment benchmarks and value-based adjustments, ensuring honest providers are not negatively impacted by fraudulent data (Section 203).

Increased Enforcement Funding: The bill appropriates $150 million for the Department of Justice and the Office of Inspector General to investigate organized fraud schemes and prosecute Medicare fraud (Section 304).

Financial Penalties for Agencies: Home health agencies that fail to submit quality data face a payment adjustment increase of 15 percentage points starting in 2029 (Section 102).

Increased Burden on Providers: Agencies at extreme risk of fraud must undergo additional screening, including fingerprinting and providing evidence of comprehensive liability insurance (Section 101).

Stricter Accreditation Requirements: Accreditation bodies may face termination of their approval if the Secretary finds their performance is deficient following a new periodic assessment mechanism (Section 103).