Wednesday, May 11, 2016

OIG Releases Enhanced Medicare Enrollment Report

Dianne De La Mare


The US Department of Health, Office of Inspector General (OIG) has released a report, Enhanced Enrollment Screening of Medicare Providers: Early Implementation Results, that discusses the Centers for Medicare & Medicaid Services’ (CMS) efforts to enhance the enrollment screening process for Medicare providers with new antifraud tools such as placing providers in risk categories, increasing site visits, requiring fingerprinting, implementing an Automated Provider Screening system and denying enrollment to providers whose owners have resolved overpayments. 

This report examines CMS’ early implementation of these new screening tools, which are intended to prevent illegitimate providers from enrolling in the Medicare program. The data in the report was obtained from CMS’ enrollment and revalidation applications submitted for the 1-year period before the implementation of enhanced screening procedures (e.g., March 25, 2010-March 24, 2011) and the 1-year period after the implementation of enhanced screening procedures (e.g., March 25, 2012-March 24, 2013). 

In the report, OIG also recommends that CMS implement the following processes:
 1) monitor contractors to determine whether they are verifying information on enrollment and revalidation applications as required; 
2) validate that contractors are appropriately considering site visit results when making enrollment decisions; 
3) revise and clarify site visit forms so that they can be more easily used by inspectors to determine whether a facility is operational; 
4) require the National Site Visit Contractor (NSVC) to improve quality-assurance oversight and training of site visit inspectors; and 
5) ensure that CMS's enrollment data system contains the complete and accurate data needed to execute and evaluate CMS's enrollment-screening enhancements.

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