CMS issues program integrity final rule for Medicare providers, suppliers

The Centers for Medicare & Medicaid Services today issued a final rule with comment period implementing additional program integrity requirements for health care providers and suppliers who participate in certain federal health insurance programs. Specifically, the final rule will require Medicare, Medicaid and Children's Health Insurance Program providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers that have: uncollected debt; been or are subject to a payment suspension under a federal health care program; been or are excluded by the Department of Health and Human Services’ Office of Inspector General from Medicare, Medicaid or CHIP; or had their Medicare, Medicaid or CHIP billing privileges denied or revoked. It provides CMS with additional authority to deny or revoke a provider's or supplier's Medicare enrollment in specified circumstances. The rule gives CMS the ability to prevent applicants from enrolling in the program for up to three years if a provider or supplier is found to have submitted false or misleading information in its initial enrollment application. In addition, the rule allows CMS to block providers and suppliers who are revoked from re-entering the Medicare program for up to 10 years. Previously, revoked providers could be prevented from re-enrolling for only up to three years. AHA provided feedback related to a number of these provisions in 2016 when CMS issued a proposed rule. The final rule is effective Nov. 4.