CMS issues program integrity rule for Medicare providers, suppliers
The Centers for Medicare & Medicaid Services today issued a that would implement additional program integrity requirements for health care providers and suppliers who participate in Medicare, as authorized by the Affordable Care Act. According to a CMS , the rule would allow the agency to remove or bar from Medicare providers and suppliers that attempt to circumvent provider enrollment requirements through name and identity changes or inter-provider relationships. The rule would require providers and suppliers to report affiliations with entities and individuals that have uncollected Medicare, Medicaid or Children’s Health Insurance Program debt; been subject to a payment suspension or Office of Inspector General exclusion; or had their Medicare, Medicaid or CHIP enrollment denied or revoked. CMS could revoke a physician or eligible professional’s Medicare enrollment if they have an “abusive” history of ordering, certifying, referring or prescribing Medicare Part A or B services, items or drugs. The rule would raise the maximum re-enrollment bar for revoked providers or suppliers from three years to 10, adding three more years if they attempt to re-enroll in Medicare under a different name, numerical identifier or business identity; and impose a maximum 20-year bar for providers or suppliers who are revoked a second time.