CMS Hospice Audits: The Rising Revocation Trend, Provider Rights, and Due Process Implications

AGG Post-Acute & Long-Term Care attorneys Bill Dombi, Jason Bring, and Lanchi Bombalier, co-authored an article for the American Health Law Association examining the Centers for Medicare & Medicaid Services’ (“CMS”) expanding authority to revoke Medicare billing privileges and the growing concerns surrounding its application to hospice providers.

The authors highlight enforcement activity in Los Angeles, Las Vegas, and Phoenix, where CMS has revoked hospice providers’ billing privileges following limited audits and subjective medical judgment determinations. In total, 181 hospices have had their Medicare enrollment revoked, with an additional 817 providers undergoing audits, raising significant due process concerns.

Bill, Jason, and Lanchi explain that while CMS cites factors such as abuse of billing privileges, its recent “guilt by association” approach may create heightened regulatory risk for compliant providers operating within complex ownership or management structures.

For providers seeking reinstatement, the attorneys emphasize that “key considerations with a request for reversal should include the specific role the party played, the past history of the individual, the value of the individual to the health care community, and other elements of the individual’s character that would lead to a favorable conclusion on any continued risks to Medicare.”

To read the full article and learn more about CMS hospice audits, AHLA members may click here.