By: Karina Gonzalez
A Final Rule recently issued by CMS will require Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) providers and suppliers to disclose current and previous affiliations (direct or indirect) with a provider or supplier that: (1) has uncollected debt; (2) has been or is excluded by the OIG (Office of Inspector General) from Medicare, Medicaid or CHIP, or (3) has had its billing privileges with either of these three programs denied or revoked. Such provider affiliations may lead to enrollment being denied if it poses a risk to fraud, waste or abuse.
The Rule is intended to prevent providers and suppliers from circumventing Medicare’s requirements through name and identity changes, as well as through elaborate inter-provider relationships.CMS will be able to deny or revoke a provider’s or supplier’s Medicare enrollment or re-enrollment if it determines that a provider or supplier is currently revoked under a different name, numerical identifier or business identity.
This Rule gives Medicare enforcement the necessary tools to take action against unqualified and potentially fraudulent entities and individuals. CMS Administrator Seema Verma noted that “fraudsters temporarily disappear into complex, hard-to-track webs of criminal entities and then re-emerge under different corporate names.” With this Final Rule, applicants whose enrollment has been revoked twice will not be permitted to reenroll for up to 20 years. Comments on the Final Rule, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC), must be received by November 4, 2019.