Providers with problematic partners will face more Medicare scrutiny under CMS proposal
Providers would have to report affiliations with individuals or groups who “pose risks” to the Medicare program under a proposed rule released by the Centers for Medicare & Medicaid Services Thursday.
The rule, which implements provisions included in the Affordable Care Act, aims to cut down on Medicare fraud by adding scrutiny to provider enrollment and weeding out individuals who pose a risk of waste, fraud or abuse.
One major provision of the rule would require providers and suppliers to report affiliations with individuals or entities that either have uncollected debt to Medicare or Medicaid, have had their reimbursements suspended, or have had their enrollment in either program denied or revoked. Medicare enrollment may be denied or revoked if CMS determines the affiliation poses a fraud risk, the agency said.
The rule would also allow CMS to deny or revoke a provider's Medicare enrollment if they're currently revoked under a different name or business identity, or if the provider has a history of abusive drug prescribing.
Removing bad actors and fraud risks from Medicare saved the program an estimated $2.4 billion between 2011 and 2015, CMS said.
Click here to read the full proposed rule. The rule will be published in the Federal Register on March 1, and will be open to public comments through 5 p.m. on April 30.