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CMS announces new rules to curb Medicare fraud



December 10, 2014
Area(s) of Interest: Fraud & Abuse Licensing & Regulatory Issues 

The Centers for Medicare and Medicaid Services (CMS) announced new rules will improve CMS’ ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare.


According to a press release, the “new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare and remove providers with patterns or practices of abusive billing." These changes are expected to save more than $327 million annually. 


CMS announced it has already removed nearly 25,000 providers from Medicare. Its strategy for curbing unscrupulous providers includes predictive analytics technology, fingerprint-based criminal background checks and temporarily freezing enrollment of new ambulances and home health providers in seven "fraud hot spots."


"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 back in," said CMS Deputy Administrator and Director of the Center for Program Integrity, Shantanu Agrawal, M.D. 


For more information, see the CMS fact sheet on this rule

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