Rep. Claudia Tenney announced Tuesday that she has introduced a House bill intended to strengthen fraud checks on Medicare home health agencies and change how federal payments to those agencies are calculated.
The New York Republican described her measure as a companion to Sen. Susan Collins’ Medicare Home Health Payment Integrity and Protection Act, which was introduced Aug. 5 and referred to the Senate Finance Committee. Tenney’s Oct. 13 announcement did not include a House bill number or the text of her version; the specific provisions below come from the available Senate bill unless otherwise noted.
Tenney said the proposal responds to suspicious Medicare billing and concerns that claims from fraudulent providers could distort the national data used to set payments for legitimate home health agencies. The bill is proposed legislation, not a change to current Medicare coverage or payment rules.
Her office pointed to Los Angeles County, saying it represented nearly 10% of national Medicare home health spending in 2024 while accounting for about 2% of traditional Medicare beneficiaries. Those figures and the allegation that suspect claims affected payment rates are the office’s claims; the announcement does not establish how much, if at all, fraudulent billing changed reimbursements.
More screening and inspections
The Senate bill would require added screening for home health agencies that federal officials classify as posing an extreme fraud risk. Beginning one year after enactment, that screening would include proof of liability insurance and, when fingerprinting is part of the agency screening process, fingerprints from the agency’s administrator.
The legislation directs the federal health secretary to consider sharp increases in the number of home health agencies in a state or county when identifying high-risk areas. The secretary could specify other risk factors as well.
Newly enrolled agencies, agencies that change ownership and agencies that reactivate Medicare billing privileges would face a standard survey at least once every 12 months for three years, beginning one year after enactment. Agencies that fail to submit required quality data or show unusual admission patterns or other warning signs would face a survey within 18 months of the previous one, subject to a limit of one such survey in any 18-month period.
The bill also would require accrediting bodies that inspect home health agencies to meet or exceed the standards used by state and local survey agencies. Their surveyors would have to complete relevant Centers for Medicare and Medicaid Services training, and CMS would gain a process for reviewing accreditor performance and addressing deficiencies.
Payment rates and data checks
The Senate proposal would set the standard Medicare home health payment amount at $2,382.87 for 2027, with later annual updates under existing law. It also would bar certain permanent and temporary adjustments tied to the difference between assumed and actual provider behavior when Medicare changed its home health payment model in 2020.
Starting in 2027, CMS would have to exclude or adjust for claims it identifies as suspect when calculating certain payment benchmarks and quality- or value-based adjustments for legitimate providers. The bill defines a suspect claim as one containing unreliable data or coming from a provider that may have engaged in fraud, waste or abuse; that designation is not itself a finding that a provider committed fraud.
Within 180 days of enactment, the federal health secretary would have to report to Congress on how suspect claims and cost reports may have affected home health payments since 2020 and recommend longer-term data safeguards. The proposal calls for notice-and-comment rulemaking to implement its screening and payment changes.
The Senate text also proposes $300 million for CMS program-integrity work, $150 million for Justice Department and federal health inspector general investigations, and $100 million for state survey activities for fiscal years 2027 through 2031. Those are proposed federal appropriations, not funds already awarded to New York agencies.
Concern in Tenney’s district
Tenney cited access to care in New York’s 24th Congressional District as one reason for backing the measure. In a November 2025 letter to CMS, she wrote that home health use in the district fell 39% from 2018 through 2024 and that two agencies serving the district had closed since 2018. Those figures describe the district, not a measured effect of the proposed bill.
In that letter, Tenney urged CMS to investigate suspect billing, examine the data behind home health payment adjustments and use its existing authority against providers when evidence warrants it. Her latest announcement does not show that billing patterns in Los Angeles caused the decline she cited in her district.
“Seniors in Upstate and Western New York should not lose access to care because of fraudulent billing schemes across the country,” Tenney said in the Oct. 13 release. The House and Senate measures would need to advance through Congress and become law before their proposed requirements could take effect.
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