CMS Strengthens Medicare Provider Safeguards with New Rule
A new final CMS rule will be make participation in Medicare incentive programs more difficult for bad actors.
- Earlier this week, RevCycleIntelligence.com covered a report from the Government Accountability Office that examined Medicare drug fraud, waste and abuse. It was released to highlight the steps being taken to prevent the system from being taken advantage of. This is just one way that government agencies are combating healthcare fraud.
The Centers for Medicare and Medicaid Services announced a new rule this week that will strengthen the oversight of Medicare providers and protect taxpayer dollars from bad actors. According to CMS Administrator Marilyn Tavenner, these new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare, removes providers with a pattern or practice of abusive billing and implements additional provisions that will resulting in savings of more than $327 million annually.
“The changes announced today are common-sense safeguards to preserve Medicare for generations to come, while making the rules more consistent for all providers that work with us,” Tavenner said in the release. “The Administration is committed to using all appropriate tools as part of its comprehensive program integrity strategy shaped by the Affordable Care Act.”
The new changes in the final rule include:
High Registered Nurse Staffing Levels Tied to Lower Mortality Rates Top 5 Facts and Misconceptions about the ICD-TEN Act 3 Trends That Will Drive Healthcare Revenue in the Future • Deny enrollment to providers, suppliers and owners affiliated with any entity that has unpaid Medicare debt. This prevents banned people or entities that have incurred debt from re-enrolling as a new business to avoid repayment of outstanding Medicare debt.
• Deny or revoke the enrollment of a provider of supplier if a managing employee has been convicted of a felony CMS officials considers detrimental to Medicare beneficiaries. These more in-depth background checks will provide additional information.
• Revoke enrollments of providers and suppliers engaging in abuse of billing privileges with a track record of providing services that do not meet Medicare requirements.
CMS will also be using new authorities created by the Affordable Care Act to limit Medicare fraud, waste and abuse. Initial provisions were agreed upon in February 2011, and are being revisited to strengthen them. There are temporary enrollment moratoria on new ambulance and home health providers in seven fraud hot spots in the U.S. that are being targeted. There are already tangible financial benefits to this approach. The Fraud Prevention System, for example, has prevented $81 million from being paid through the use of predictive analytics technology to identify problem providers and suppliers.
According to Shantanu Agrawal, MD, CMS Deputy Administrator and Director of the Center for Program Integrity, CMS has already removed nearly 25,000 providers from Medicare and the new rules will help keep them from re-enrolling and costing more money.
“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,” Agrawal said.
