Tuesday, September 17, 2019

Expanded CMS Authority to Deny Medicare Providers

The Centers for Medicare and Medicare Services (CMS) recently finalized a new rule to strengthen protections against Medicare or Medicaid fraud, waste and abuse. The rule goes into effect November 4, 2019. The agency is finalizing the following actions:
  • Implement a provision of the Patient Protection and Affordable Care Act that requires Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) providers and suppliers to disclose any current or previous direct or indirect affiliation with a provider or supplier that: (1) has uncollected debt; (2) has been or is subject to a payment suspension under a federal health care program; (3) has been or is excluded by the Office of Inspector General (OIG) from Medicare, Medicaid, or CHIP; or (4) has had its Medicare, Medicaid, or CHIP billing privileges denied or revoked.
  • Based on these disclosures, the rule permits CMS to deny Medicare enrollment for a provider’s affiliation with a provider or supplier that pose an undue risk of fraud, waste, or abuse.
  • Gives CMS more ability to revoke or deny individuals or organizations from becoming enrolled as a Medicare provider in specified circumstances.
  • Increases the maximum reenrollment bar from 3-10 years in specified circumstances
AHCA will monitor the effects of CMS’s new authority to deny Medicare enrollment based on a provider’s affiliations. Providers should check the Office of Inspector General’s List of Excluded Individuals or Entities for affiliated providers or suppliers.

CMS has also requested comments specifically on obtaining affiliation information from providers and suppliers other than those to which § 424.519(b) will apply. They are looking for information on the timing, mechanism and priority. Comments are due November 4. After these comments are received, CMS will go through the formal notice and comment rulemaking process.

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