Hospice billing privilege revocation and hospice revocation are one search term for two different things. One is a patient's choice to leave hospice care. The other is CMS cutting off a hospice provider's ability to bill Medicare at all. When CMS suspends a hospice's Medicare payments or revokes its billing privileges, the hospice is defending its right to participate in the program, not a single disputed claim, and heightened oversight of new hospices plus a nationwide enrollment moratorium add further exposure in 2026.
Patient Election Revocation Is Not a CMS Billing Privilege Revocation
Under 42 CFR 418.28, a hospice patient or representative can revoke the patient's election of hospice care at any time by filing a statement with the hospice, and the patient resumes standard Medicare coverage of the benefits waived during the election. That is a clinical and coverage decision made by the patient. A CMS revocation of billing privileges under 42 CFR 424.535 is a different, provider-facing enforcement action that bars the hospice from billing Medicare for any patient, not just the one who revoked an election.
What a Payment Suspension Notice Says
Under 42 CFR 405.371, CMS or its Medicare Administrative Contractor can suspend a hospice's payments, in whole or in part, on reliable information of an overpayment or incorrect payments, or, after consulting HHS-OIG, a credible allegation of fraud. The hospice can file a rebuttal statement within 15 days under 42 CFR 405.374, and the contractor must consider it within 15 days. A fraud-based suspension skips the standard 180-day limit under 42 CFR 405.372; CMS instead evaluates it every 180 days and requests certification from OIG or law enforcement that the matter remains under investigation, under 42 CFR 405.371. There is no administrative appeal of the suspension itself, so the rebuttal is the hospice's only chance to be heard before payments stop.
What a Billing Privilege Revocation Notice Says
A revocation under 42 CFR 424.535 ends the hospice's Medicare billing privileges outright, on grounds that range from noncompliance with Medicare's enrollment requirements to false information on an enrollment application to an affiliation CMS deems an undue risk of fraud, waste, or abuse. Revocation carries a reenrollment bar of one to ten years, and a second revocation can draw a bar of up to twenty years. A hospice can request reconsideration, and further review if unsuccessful, under 42 CFR Part 498; filing promptly preserves the record before the bar takes effect.
Heightened Oversight of New Hospices and the Current Enrollment Moratorium
CMS runs a Provisional Period of Enhanced Oversight (PPEO) for newly enrolling hospices, and an Expanded Prepayment Review (EPR) for existing ones. PPEO began July 13, 2023 for newly enrolling, ownership-changing, or reactivating hospices in Arizona, California, Nevada, and Texas, and EPR began September 17, 2024 for existing hospices in those four states; Georgia and Ohio were added to both on December 30, 2025. PPEO can include medical review of a hospice's claims, including prepayment review, for a period CMS sets of 30 days to one year, and EPR's initial review volumes start low and are adjusted based on the results. Separately, CMS imposed a national moratorium on new hospice and home health enrollment effective May 13, 2026, for an initial six months, extendable in six-month increments; as of October 2026, no extension or lifting of it had appeared in the Federal Register. That federal moratorium is separate from California's state licensing moratorium on new hospice licenses under Senate Bill 664, a state Department of Public Health action, not a CMS rule.
How These Enforcement Actions Stack
A suspension, a revocation, PPEO review, and the moratorium are not mutually exclusive. A hospice under EPR with adverse findings on the eligibility documentation covered in Hospice Medicare Audits and Eligibility Challenges can move from prepayment denials into a fraud-based suspension, and the same findings can later support a revocation. A hospice weighing whether to request immediate recoupment after a related audit, covered in Immediate Recoupment: Should You Request It, should know a pending suspension changes that calculus, and a home health agency pursuing a change of ownership during the moratorium faces that freeze on top of any PPEO oversight.
A payment suspension can run with no administrative right of appeal while CMS revisits it every 180 days, and a revocation can end a hospice's Medicare billing privileges with a reenrollment bar of up to ten years.
Why Early Legal Counsel Is Critical
It is critical that hospices promptly retain experienced healthcare defense counsel upon receiving a payment suspension notice, a revocation notice, or a PPEO or EPR notification letter. Early legal intervention can protect the hospice's rights, shape the rebuttal or reconsideration record before the response window closes, avoid inadvertent admissions during the records exchange, and allow counsel to communicate with the contractor or CMS on the hospice's behalf. Delaying representation can turn a suspension into a revocation, and a revocation into a years-long reenrollment bar.
How Health Law Alliance Can Help
Health Law Alliance's attorneys have overseen 2,000+ audits and handled 5,000+ matters, with 25+ years of experience. If your hospice has received a payment suspension notice, a revocation of billing privileges, or a PPEO or EPR notification letter, contact Health Law Alliance's Medicare audit defense attorneys for a free, confidential consultation before the response window closes.
