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# Medicare Can Now Revoke Providers Retroactively, Clawing Back Pay To Day One Of Noncompliance
- URL: https://www.bullished.co/medicare-can-now-revoke-providers-retroactively-clawing-back-pay-to-day-one-of-9e127f0f/
- Published: 2026-11-04T22:23:45.000Z
- Updated: 2026-11-04T22:23:45.000Z
- Description: CMS says its final home health rule will save taxpayers about $82 million a year and lifts agency payments about 2.4% for CY 2027.
- Author: Matteo Parrino
- Tags: Markets, Industry: Healthcare, Topic: Health & Drug Regulation

The Centers for Medicare & Medicaid Services (CMS), which runs Medicare, finalized a rule that lets it make enrollment revocations effective as of the date a provider's noncompliance began, so it can recover payments back to that point. The agency said in [a release](https://www.cms.gov/newsroom/press-releases/cms-finalizes-broad-medicare-integrity-changes-home-health-final-rule-expected-save-taxpayers-tens?ref=bullished.co) that the changes are expected to save taxpayers approximately $82 million annually.

## Clawback power across provider types

The new protections apply to all Medicare provider and supplier types, though they sit inside the Calendar Year (CY) 2027 Home Health Prospective Payment System final rule. CMS said the aim is to recover money from noncompliant providers and keep high-risk ones from entering or staying in the program.

The rule also adds grounds for denying or revoking enrollment. They include certain misdemeanor convictions tied to sexual assault or financial misconduct, and enrollments that pose a high risk of fraud, waste and abuse because providers and suppliers are excessively concentrated in a limited geographic area.

CMS said the authorities are targeted in scope and that it will weigh the facts and circumstances of each case while preserving beneficiaries' access to care. Stricter requirements for hospices and home health agencies on ownership changes and administrator qualifications are also part of the rule.

CMS Administrator Dr. Mehmet Oz said: "The Trump Administration is taking action to hold noncompliant providers accountable and ensure Medicare works with legitimate, qualified providers."

## A 2.4% raise and faster quality data

For CY 2027, CMS estimates Medicare payments to home health agencies will rise approximately 2.4% compared with CY 2026\. The rule keeps a 3% temporary adjustment, consistent with last year's approach, as CMS carries out its statutory duty to move the payment system to the Patient-Driven Groupings Model in a budget-neutral way.

The rule shortens the deadline for agencies to submit Outcome and Assessment Information Set data from 135 days to 45 days. CMS expects that to make public quality information available up to three months sooner. About 98% of agencies already submit within 45 days, so the change mostly reflects existing practice.

CMS also collected and summarized information on advance care planning as a potential future quality measure concept. The rule includes updates on durable medical equipment, prosthetics, orthotics, and supplies as well.

## Palliative care under the home health benefit

The rule discusses how Medicare's existing home health benefit can cover skilled palliative care, including pain and symptom management at home, for eligible patients with serious illnesses. CMS said this addresses provider uncertainty that may have limited use, and that it creates no new benefit.

Eligibility turns on a patient's care needs and whether they meet Medicare's home health criteria, not on a specific diagnosis. CMS said palliative care under the benefit is distinct from hospice.

CMS said it plans to issue guidance with additional examples of skilled palliative care after the final rule is published.

### Sources

- [CMS Finalizes Broad Medicare Integrity Changes in Home Health Final Rule; Expected to Save Taxpayers Tens of Millions of Dollars](https://www.cms.gov/newsroom/press-releases/cms-finalizes-broad-medicare-integrity-changes-home-health-final-rule-expected-save-taxpayers-tens?ref=bullished.co) — Centers for Medicare & Medicaid Services
- [Medicare spends more on hospices owned by private equity firms, study finds | Healthcare Dive](https://www.healthcaredive.com/news/medicare-spends-more-hospices-owned-private-equity-firms-study-finds/873773/?ref=bullished.co) — healthcaredive.com
- [Medicare Fraud: Has Your Doctor Been Flagged? | Kiplinger](https://www.kiplinger.com/retirement/medicare/medicare-fraud-has-your-doctor-been-flagged?ref=bullished.co) — kiplinger.com
- [The 2026 election wins could allow Democrats to tackle healthcare costs. What can they do? | Vox](https://www.vox.com/health/509042/2026-us-election-results-congress-healthcare-costs?ref=bullished.co) — vox.com
- [AlayaCare announces new Medicare home health solution,](https://www.globenewswire.com/news-release/2026/11/03/3394587/0/en/alayacare-announces-new-medicare-home-health-solution-bringing-every-line-of-care-onto-one-intelligent-platform.html?ref=bullished.co) — globenewswire.com
- [Health Plan Unlocks More Than $10M in Savings in Six Months Using Cohere Health's AI-Powered Pre-Payment Review](https://www.prnewswire.com/news-releases/health-plan-unlocks-more-than-10m-in-savings-in-six-months-using-cohere-healths-ai-powered-pre-payment-review-302928369.html?ref=bullished.co) — prnewswire.com