Earlier this week, September 5, the federal government finalized a rule, “Program Integrity Enhancements to the Provider Enrollment Process”, whichexpands the power of the Centers of Medicare & Medicaid Services (CMS) to remove providers from Medicaid (and Medicare) eligibility. The rule is scheduled to take effect November 4, 2019, and allows CMS to revoke Medicaid eligibility from providers based on a previous association with a banned organization.
Under the new final rule, the Centers for Medicare & Medicaid Services (CMS) has the authority to revoke program eligibility if a provider:
- has a previous affiliation with a banned organization, even if the provider itself has not been directly hit with a federal investigation
- bills for services or supplies from “non-compliant locations”
- demonstrates a pattern of improper ordering of services, supplies, or drugs under Medicare Parts A or B
- possesses outstanding debt related to Medicare or Medicaid overpayments.
- attempts to return to the program under a different name than previously utilized and revoked.
The new rule also increases the ban from Medicare participation from three to 10 years for “fraudulent or otherwise problematic” providers and imposes three-year bans to providers that misrepresent themselves on their initial Medicare application. Providers that receive a ban, return, and commit another offense are subject to a twenty year ban.
CMS’ Press Release can be found here: https://www.cms.gov/newsroom/press-releases/cms-announces-new-enforcement-authorities-reduce-criminal-behavior-medicare-medicaid-and-chip