3, 2014 - New rules that strengthen oversight of Medicare providers and
protect taxpayer dollars from bad actors were announced today by Marilyn
Tavenner, administrator of the Centers for Medicare and Medicaid
Services. The new safeguards are designed to prevent physicians and
other providers with unpaid debt from re-entering Medicare, remove
providers with a pattern or practice of abusive billing and implement
other provisions to help save more than $327 million annually.
The changes announced today are
common-sense safeguards to preserve Medicare for generations to come,
while making the rules more consistent for all providers that work with
us, Tavenner said.
The Administration is committed to
using all appropriate tools as part of its comprehensive program
integrity strategy shaped by the Affordable Care Act.
CMS Deputy Administrator and
Director of the Center for Program Integrity, Shantanu Agrawal, M.D.,
said, CMS has removed nearly 25,000 providers from Medicare and the new
rules help us stop bad actors from coming back in as we continue to
protect our patients. For years, some providers tried to game the system
and dodge rules to get Medicare dollars; today, this final rule makes it
much harder for bad actors that were removed from the program to come
CMS is using new authorities
created by the Affordable Care Act to clamp down on Medicare fraud,
waste and abuse.
CMS currently has in place
temporary enrollment moratoria on new ambulance and home health
providers in seven fraud hot spots around the country. The moratoria are
allowing CMS to target its resources in those areas, including use of
fingerprint-based criminal background checks. These and other successes
continue to protect the Medicare Trust Funds.
CMS claims it has demonstrated that
removing providers from Medicare has a real impact on savings. Cited as
an example, the Fraud Prevention System, a predictive analytics
technology, identified providers and suppliers who were ultimately
revoked, and prevented $81 million from being paid.
New changes announced today allow
● Deny enrollment to providers,
suppliers and owners affiliated with any entity that has unpaid Medicare
debt; this will prevent people and entities that have incurred
substantial Medicare debts from exiting the program and then attempting
to re-enroll as a new business to avoid repayment of the outstanding
● Deny or revoke the enrollment
of a provider or supplier if a managing employee has been convicted of a
felony offense that CMS determines to be detrimental to Medicare
beneficiaries. The recently implemented background checks will provide
CMS with more information about felony convictions for high risk
providers or suppliers.
● Revoke enrollments of providers
and suppliers engaging in abuse of billing privileges by demonstrating a
pattern or practice of billing for services that do not meet Medicare
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