Reducing fraud goal of new CMS rule

The Centers for Medicare & Medicaid Services (CMS) has announced a new rule designed to help save more than $327 annually by increasing oversight of Medicare providers.

Specifically, the new changes allow CMS to:

  • Deny enrollment to providers, suppliers and owners affiliated with any entity that has unpaid Medicare debt. This ablity is designed to prevent people and entities that have incurred substantial Medicare debts from exiting the program and then attempting to re-enroll as a new business to avoid repayment of the outstanding Medicare debt.
  • Deny or revoke the enrollment of a provider or supplier if a managing employee has been convicted of a felony offense that CMS determines to be detrimental to Medicare beneficiaries. The recently implemented background checks will provide CMS with more information about felony convictions for high-risk providers or suppliers.
  • Revoke enrollments of providers and suppliers engaging in abuse of billing privileges by demonstrating a pattern or practice of billing for services that do not meet Medicare requirements.

“CMS has removed nearly 25,000 providers from Medicare, and the new rules help us stop bad actors from coming back in as we continue to protect our patients,” Shantanu Agrawal, MD, CMS deputy administrator and director of the Center for Program Integrity, said in a statement. “For years, some providers tried to game the system and dodge rules to get Medicare dollars. This final rule makes it much harder for bad actors that were removed from the program to come back in.”

CMS is using new authorities created by the Affordable Care Act to battle Medicare fraud, waste and abuse. The federal agency has posted a fact sheet about the final rule on its website.

Topics: Medicare/Medicaid