CMS issues program integrity rule for Medicare providers, suppliers

The Centers for Medicare & Medicaid Services today issued a proposed rule that would implement additional program integrity requirements for health care providers and suppliers who participate in Medicare, as authorized by the Affordable Care Act. According to a CMS factsheet, the rule would allow the agency to remove or bar from Medicare providers and suppliers that attempt to circumvent provider enrollment requirements through name and identity changes or inter-provider relationships. The rule would require providers and suppliers to report affiliations with entities and individuals that have uncollected Medicare, Medicaid or Children’s Health Insurance Program debt; been subject to a payment suspension or Office of Inspector General exclusion; or had their Medicare, Medicaid or CHIP enrollment denied or revoked. CMS could revoke a physician or eligible professional’s Medicare enrollment if they have an “abusive” history of ordering, certifying, referring or prescribing Medicare Part A or B services, items or drugs. The rule would raise the maximum re-enrollment bar for revoked providers or suppliers from three years to 10, adding three more years if they attempt to re-enroll in Medicare under a different name, numerical identifier or business identity; and impose a maximum 20-year bar for providers or suppliers who are revoked a second time.