CMS Proposes Expansion of Medicare Enrollment and Revocation Authority
For most healthcare providers, Medicare enrollment and participation is essential to the financial health of their practice. Yet many providers are unaware of the growing number of circumstances that can lead the Centers for Medicare and Medicaid Services (CMS) to deny or revoke Medicare billing privileges, often with devastating operational and financial consequences. CMS has now proposed expanding its enrollment and revocation authority even further, making it more important than ever for providers to understand the rules governing Medicare participation and maintain strong compliance practices.
Key Proposed Changes
As part of its ongoing program integrity efforts, the proposed rule seeks to expand CMS’s authority to deny or revoke Medicare enrollment through the following key changes:
· All Revocations Could Become Retroactive. Under the current rule, certain grounds for revocation impose retroactive effective dates, but many take effect prospectively after the revocation notice is sent. Under the new proposed rule, every Medicare revocation would be retroactive to the date noncompliance began. This would allow CMS to recoup Medicare payments made during the entire period of noncompliance, significantly increasing providers’ financial exposure.
· New and Expanded Grounds for Enrollment Denial and Revocation. CMS proposes to significantly expand its authority to deny or revoke Medicare enrollment by creating several new enforcement tools and broadening existing authorities. While not an exhaustive list, some of the most notable proposed changes include:
- Violations of the 36-Month Rule. Authority to revoke enrollment of home health agencies, hospices, and DMEPOS suppliers that fail to comply with Medicare’s change-in-majority-ownership (36-month) enrollment requirements.
- Expanded License and Program Suspension Authority. Authority to deny or revoke enrollment based on license or program suspensions affecting not only the provider, but also certain owners, managing employees or managing organizations.
- Geographic Risk-Based Denials and Revocations. Authority to deny or revoke enrollment when CMS determines a provider’s location presents a heightened fraud, waste or abuse risk because of an excessive concentration of providers in a limited geographic area, even without an actual finding of fraud.
- Additional Criminal Conviction Grounds. Authority to deny or revoke enrollment based on certain misdemeanor convictions involving sexual assault or financial misconduct within the previous 10 years.
- Shared Office Space Restrictions. Authority to deny enrollment based on sharing a suite or office with another provider or supplier whose Medicare enrollment has been denied or revoked, even absent any independent wrongdoing by the applicant.
- Cross-Enrollment Revocation. Authority to revoke a provider’s or supplier’s other Medicare enrollments when one enrollment triggers a denial.
- Expanded Reapplication Bars Following Enrollment Denial. Authority to impose a reenrollment bar of up to 10 years for any denial reason. Under the current regulations, a 10-year reenrollment bar is limited to denials involving false or misleading information submitted on an enrollment application.
What Providers Should Do
Providers should expect broader enforcement and greater financial risk associated with enrollment deficiencies. Although the proposed rule is not yet final, providers should take this opportunity to evaluate their Medicare enrollment compliance processes. Consider the following best practices:
· Conduct periodic Medicare enrollment audits. Verify that information reported in Provider Enrollment, Chain and Ownership System (PECOS) and CMS-855 enrollment applications remains complete and accurate. Timely report changes to ownership, managing employees, practice location and hours and other reportable changes.
· Review ownership transactions carefully before completing mergers, acquisitions, buy-ins or ownership restructurings. Perform due diligence to screen prospective owners, officers, directors and managing employees for criminal convictions, licensure actions, exclusions and other issues that could affect Medicare enrollment eligibility.
· Understand all enrollment requirements and ensure accurate information before submitting a new enrollment application.
· Maintain documentation supporting compliance.
· Consult counsel before significant organizational changes.
Interested in Commenting on the Proposed Rule?
CMS is accepting public comments on the proposed rule before issuing a final rule. Providers, industry associations and other stakeholders should consider submitting comments, particularly if you believe the proposed enrollment and revocation changes would create unintended burdens or operational challenges.
Comments may be submitted electronically through the Federal eRulemaking Portal at Regulations.gov by searching for CMS-2026-2311 and following the online instructions.
Comments must be submitted no later than Aug. 31, 2026.
