The new rule gives CMS greater authority to bar the perpetrators of Medicare, Medicaid, and CHIP fraud and their affiliates from enrollment and could save billions.
A CMS rule expands its ability to revoke or deny providers’ position serving in federal networks in an effort to combat fraud in Medicare, Medicaid, and CHIP.
“The provisions we are finalizing in this rule are necessary to address various program integrity issues and vulnerabilities,” the rule explained. “We believe that these provisions will help make certain that entities and individuals who pose risks to the Medicare and Medicaid programs and CHIP are removed from and kept out of these programs; this final rule with comment period will also assist in preventing providers and suppliers from circumventing Medicare requirements through name and identity changes, as well as through elaborate, inter-provider relationships.”
Federal programs like Medicare and Medicaid are common targets for fraudulent activity.
In 2017, the Department of Justice (DOJ) retrieved $2.4 billion from Medicare, Medicaid, and federal healthcare programs. This accounted for 64 percent of the takings from all federal fraudulent cases that year. In 2018, the DOJ raked in $27.68 million in False Claims Act violations alone.
In the last five years, CMS noted in the rule, over 2,000 entities have been affiliated with other entities or individuals whose Medicare enrollment was revoked and the 2,000 entities received $51.9 billion, including adjusted factors, from CMS.
Date: September 10, 2019
Source: Health Payer Intelligence