Senior Care Policy Brief: CMS Tightens Audits as Errors Persist

• The Centers for Medicare & Medicaid Services (CMS) has again delayed implementation of federally mandated nursing home ownership disclosure requirements enacted under Section 6101 of the Affordable Care Act. By indefinitely suspending the off-cycle Medicare revalidation process – the primary mechanism for collecting this information – CMS has removed any clear deadline for facilities to disclose who owns, controls, and profits from nursing homes. Read LTCCC’s statement on this decision.
• Senior living acquisitions topped $10.3 billion through the third quarter of 2025, signaling a strong rebound in investor activity, according to NIC MAP data.
  • At the same time, many owners and operators continue to claim they lack sufficient resources to properly staff facilities and care for residents – highlighting a troubling disconnect in the nursing home industry between strong investment activity and persistent assertions of financial distress.

• CMS is strengthening audit and oversight efforts as improper Medicare payments continue to increase, with nursing homes cited as leading all provider types in documentation errors, according to recent reporting by Skilled Nursing News. Federal reviewers found persistent problems with incomplete, inaccurate, or unsupported claims – prompting CMS to expand targeted audits, increase data analysis, and sharpen enforcement tools aimed at reducing waste and abuse in long-term care billing.
  • This heightened scrutiny aligns with concerns raised in LTCCC’s December webinar, which examined how private equity and real estate investment trust involvement can undermine transparency and accountability. The webinar underscores that weak oversight and opaque financial practices not only fuel improper payments but also divert resources away from staffing and resident care – reinforcing the need for strong regulatory guardrails.

Image via LTCCC’s Dec. 2025 webinar, The Expanding Role of Big Finance in Long-Term Care, presented by Ed Dudensing.

• A new study finds that the predictable timing of nursing home inspections leads facilities to cycle their staffing and care efforts, with lower effort – and higher mortality risk – in periods when inspections are unlikely, and improved care as inspections approach. Researchers estimate that making inspections less predictable could save about 12% more lives without additional cost. The resulting impact would be comparable to increasing inspection frequency by 12%. The findings suggest that unpredictable inspection schedules are a powerful and underused policy tool to improve staffing, protect residents, and strengthen compliance in nursing homes.