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CMS announces rules that enhance Medicare provider oversight

The Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavennar recently announced new rules that strengthen oversight of Medicare providers. 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.

According to CMS Deputy Administrator and Director of the Center for Program Integrity, Shantanu Agrawal, M.D., "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. For years, some providers tried to game the system and dodge rules to get Medicare dollars; today, this final rule makes it much harder for bad actors that were removed from the program to come back in."

Under the Affordable Care Act, CMS is clamping down on Medicare fraud, waste and abuse. The new changes allow CMS to:

  • 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.

Because of changes such as these, our OIG/CMS Fraud, Waste and Abuse module has been updated with important information to ensure your organization understands what constitutes and how to safeguard against fraud, waste and abuse.

If you have any questions about HITECH, or any compliance questions please feel free to comment below or send us an email [email protected] , or reach us by phone 855-427-0427.

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