CMS cracking down on fraudsters

Federal agencies are stepping up their efforts to go after providers who engage in healthcare fraud and abuse.

On Dec. 3, the Centers for Medicare & Medicaid services issued new rules designed to crack down on what the agency refers to as “bad actors,” as part of an effort to increase oversight of Medicare providers, as well as save taxpayers money.

The new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare, remove providers with patterns or practices of abusive billing, and implement other provisions to help save more than $327 million annually, CMS said in a news release.

CMS is using new authorities created by the Affordable Care Act to go after Medicare fraud, waste and abuse.

The new rules include the following changes:

  • Deny enrollment to providers, suppliers and owners affiliated with any entity that has unpaid Medicare debt; this will 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 believes the crackdown will save $327 million annually.

Nearly 25,000 providers have been removed from Medicare and the new rules are designed to keep them from coming back.

Earlier this year, CMS issued a temporary moratorium on enrolling new home health agencies and ambulance suppliers in what it deemed to be seven healthcare fraud “hotspot” states including Florida.

Medicare providers would be well advised to make sure they are engaging in proper billing practices. Those who have been targeted by CMS should seek counsel for advice as to what steps they need to take or face the risk of losing their enrollment status.

Click here to read the final rule.

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The Health Law Offices of Anthony C. Vitale

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