CMS crackdown doubles Medicare removals

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Dressing "bare below the elbow" is recommended by SHEA.
Dressing "bare below the elbow" is recommended by SHEA.

The Centers for Medicare & Medicaid Services has removed 14,663 healthcare providers and suppliers from the Medicare program in the last two years, the agency announced Thursday. The figure more than doubles the number of removals from the prior two-year period. The statistics do not break down removals by provider type, but they support long-term care stakeholders who have noted increased enforcement actions. 

CMS said it has used resources from the Affordable Care Act to crack down on waste, fraud and abuse. The agency said it used technology to transition from a chase-and-pay approach to a more proactive strategy — one that uses data analysis to identify potential problems.

A compliance expert cautioned long-term care providers about CMS' new Fraud Prevention System in a recent McKnight's Super Tuesday webcast. While technology can catch bad actors, it's also a crucial way to maintain compliance, advised Alliance Training Center Executive Director Leah Klusch, RN, BSN, FACHCA. She advocated for programs that electronically compare Minimum Data Set and billing data so administrators can catch problems early.

In 18 states, the number of Medicare revocations has quadrupled since the healthcare reform law took effect, according to CMS. The number of states with more than 600 revocations went from three to six, with New York, Ohio and Pennsylvania joining California, Texas and Florida.

The agency has revoked Medicare eligibility because providers are not in compliance with rules, are not operating from the address on file, or because of felony convictions.

CMS is now looking to increase beneficiary involvement in anti-fraud efforts. Medicare Summary Notices have been redesigned to make it easier for beneficiaries to spot problematic claims, CMS announced. The notices will be mailed on a quarterly basis.