Healthcare Services "Weekly Check-Up: Retail Pharmacy and Managed Care ..."

Research evidence excerpt

Healthcare Services "Weekly Check-Up: Retail Pharmacy and Managed Care ..."

home health agencies (HHAs) effective May 13,

2026. This announcement is part of an effort by the Trump administration to crackdown

on fraud, waste, and abuse in Medicare, while CMS noted that this moratoria will allow

it to temporarily halt the influx of new providers into these high-risk categories. During

the 6-month moratoria, CMS said it will intensify targeted investigations, deploy

advanced data analytics, and accelerate the removal of hospice and HHA providers from

the Medicare program that are suspected of committing fraud. This nationwide

approach is said to also eliminate the ability of bad actor operators to evade detection by

simply shifting across state lines. In addition, CMS said the moratoria will apply to all

applications for initial Medicare enrollment and certain changes in majority ownership,

which are frequently used to obscure control by bad actors. Importantly, the moratoria

will not impact current enrollments, and existing providers can continue to deliver

services to Medicare beneficiaries. From our understanding, this moratoria does not

prohibit providers taking new patients, and instead is prohibiting the licensing of new

HHAs and hospice providers for Medicare. We do not think this action will have a

material impact on the operations of hospice and HHA providers within our coverage

(e.g. ADUS, AVAH, BTSG, EHAB), although it could potentially have an impact on

expansion efforts for these companies.(Link to Note)

5/13/26 Conference Recaps (May 13, 2026)

CI - Breaking Down the Large PBM Contract Profiles: CI covered more details on its

Signature rebate-free PBM model as well as the dynamics around its three largest

contracts (Centene, Prime, and DoD).