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CMS Releases Proposed Rule to Revise Provider Enrollment Provisions and the Incentive Reward Program

On April 24, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that increases CMS’ ability prevent fraudulent Medicare providers from enrolling, or remaining enrolled in the Medicare program. The provisions that CMS proposes to implement include:

  • Allowing CMS to deny the enrollment of any provider, supplier or owner affiliated with an entity that has unpaid Medicare debt in order to prevent entities with such debt to avoid repayment by leaving the Medicare program and re-enrolling as a new business.
  • Denying enrollment or revoking a provider or supplier’s Medicare billing privileges if a managing employee has been convicted of certain felony offenses.
  • Revoking the Medicare billing privileges of providers and suppliers that are found to have a pattern of billing for items or services in a manner not accordance with Medicare billing requirements.
  • Making the effective date of Medicare billing privileges (typically, the date in which the enrollment application was filed) consistent across certain provider/supplier types.

In addition to the proposed changes to the Medicare enrollment provisions, CMS also proposes to increase the potential reward amount to people that provide tips of Medicare fraud and abuse. The proposed changes would increase the reward percentage for recovered Medicare funds from 10% to 15%, and would substantially increase the reward cap from $1,000 to $9.9 million.

If you have any questions regarding these recent developments, or have any questions relating to the Anti-Kickback Statute, Stark Law or other federal or state fraud and abuse regulations, please contact an experienced health care attorney at Wachler & Associates at 248-544-0888.