CMS Expands Use of "Affiliation Risk" Rule, Increasing Compliance Exposure

CMS is significantly increasing enforcement of its “affiliation risk” rule, allowing the agency to revoke Medicare participation for providers connected to organizations flagged for fraud, waste, or abuse. The rule is now being applied more broadly, sometimes retroactively, and does not require the facility itself to be under investigation. Shared ownership, leadership, or even medical directors can trigger action, placing nursing homes at risk of sudden billing disruptions. Providers are being urged to closely monitor affiliations, verify clinician enrollment status, and maintain accurate records to avoid unexpected compliance consequences.

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