CMS Widens Power to Revoke Medicare Billing Privileges

A new final rule lets regulators deny or revoke Medicare enrollment over misconduct by a provider's owners or parent companies.

Updated on Nov. 6, 2026 in Healthcare

CMS Widens Power to Revoke Medicare Billing Privileges

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The Centers for Medicare & Medicaid Services finalized a rule expanding its authority to deny or revoke Medicare enrollment based on violations committed by a company's owners or parent companies. The change, included in the 2027 Home Health Prospective Payment System final rule, applies retroactively to when CMS or its contractors notify providers of noncompliance.

Why it matters

Regulators said statutory blind spots had limited their ability to identify and stop fraud as ownership changes accelerated over the last decade. The rule is intended to hold bad providers accountable, and CMS projects it will save taxpayers $82 million annually.

CMS projects $82 million in annual taxpayer savings from the rule. The provision expands enforcement from a provider's own violations to those of owners and parent companies, including license suspensions in other states and suspensions from other federal healthcare programs.

The players

Centers for Medicare & Medicaid Services (CMS)

The federal agency that administers Medicare and sets enrollment, billing, and payment rules for healthcare providers across the United States.

The details

Under the rule, violations such as license suspension or revocation in another state, or suspension from another federal healthcare program, can now trigger denial or revocation of Medicare enrollment. Home health agencies, hospices, and medical equipment suppliers must also re-enroll as new Medicare providers when they undergo a change in majority ownership, and failing to complete new accreditation could cause them to lose billing or enrollment ability.

Earlier in 2026: CMS enacted a six-month pause on new Medicare enrollments for home health and hospice providers.
July 2026: A hospice final rule raised rates 2.3%, or $755 million, and introduced a Service and Spending Variation Index.
November 4, 2026: CMS released the final rule on Medicare billing privileges.
2027: Home health agencies receive a 2.4% pay increase totaling $415 million.

Roadmap

The rule extends CMS's enforcement authority beyond individual providers to the ownership structures behind them, a response to the rapid pace of ownership changes in home health, hospice, and equipment supply over the past decade. It sits alongside the agency's recent six-month enrollment pause and its July hospice rule, which together tighten oversight of post-acute Medicare providers.

Home health agencies, hospices, and medical equipment suppliers that change majority ownership must re-enroll as new Medicare providers. Providers that fail to complete new accreditation could lose their ability to bill or enroll in Medicare.

The takeaway

Medicare providers should review their ownership structures and accreditation status now, since violations by owners or parent companies can now affect their enrollment. Retroactive enforcement means past notices of noncompliance may carry consequences under the new rule.