CMS Proposes Additional Fraud Fighting Measures Affecting Medicare Enrollment

Posted on Health Care Law News by author

On April 29, 2013, CMS issued a proposed rule that contains a number of measures designed to help curb Medicare fraud, waste, and abuse.  More specifically, the proposed rule would:

  • Increase rewards paid to Medicare beneficiaries and others under the “Incentive Reward Program” whose tips about fraud lead to the recovery of funds;
  • Allow CMS to deny enrollment or revoke billing privileges for providers and suppliers if an owner or managing employee has been convicted of a felony offense that CMS determines to be “detrimental to the best interests” of the Medicare program and its beneficiaries;
  • Allow CMS to deny enrollment to providers and suppliers with an ownership interest (former or current) in an entity that has unpaid Medicare debt; and
  • Allow CMS to revoke billing privileges for providers and suppliers who have a pattern or practice of billing for services that do not meet Medicare requirements.

CMS has asked for comments on the proposed rule, which will be accepted until June 28, 2013.  With respect to the last three proposals, there are inherent and acknowledged ambiguities (such as the meaning of the phrases “detrimental to the best interests of the Medicare program,” “ownership interest,” and “pattern or practice”) and therefore a high risk of inconsistent and/or unfair application by CMS, which in our view necessitates much better elucidation and discussion before issuance of a Final Rule.

The attorneys at Nicholson & Eastin, LLP, are available to assist providers with questions concerning these proposed changes, and with Medicare enrollment issues.