News Briefs Archive

New CMS Rule Targets Health-Care Providers’ Affiliates

Oct. 9, 2019

The Centers for Medicare & Medicaid Services will be able to revoke health-care providers, or suppliers’, Medicare enrollment if they are affiliated with targeted “bad actors,” according to reporting by Alex Kacik in Modern Healthcare.

As part of the CMS’ “Program Integrity Enhancements to the Provider Enrollment Process” going into effect Nov. 4, its new “affiliations” provision allows authorities to bar individuals and organizations that “pose an undue risk of fraud, waste or abuse based on their relationships with other sanctioned entities.”

Medicare, Medicaid and CHIP providers will have to disclose any current or previous affiliation with an organization that has uncollected debt, has had a payment suspension under a federal health-care program, has been excluded from those programs, or has had billing privileges denied or rescinded.

In addition, the CMS will be able to revoke or deny Medicare enrollment if providers or suppliers attempt to get back into the program under a different name, bill for services from non-compliant locations, exhibit a fraudulent or wasteful pattern of ordering services or drugs, or have an outstanding debt to the CMS from an over-payment that was referred to the Treasury Department. The agency may also prohibit an organization from participating in the Medicare for up to three years if they falsify their enrollment application.

The new rule will cost providers and suppliers $937,500 in each of the first three years of implementation to gather all their affiliation documentation, the agency estimates. The new revocation guidelines will lead to approximately 2,600 new withdrawals a year, netting an estimated $4.16 billion over a 10-year period, the CMS said. The agency could also save up to $4.48 billion over 10 years with the new re-application provisions.

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