Industry News

CMS, OIG Issue Final Rule to Implement Anti-Fraud Measures Authorized by PPACA.

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services Office of Inspector General (OIG) jointly issued a final rule implementing several Patient Protection and Affordable Care Act (PPACA) provisions. The provisions are aimed at reducing fraud, waste, and abuse in federal health care programs. Some of the newly implemented provisions include establishing screening procedures for providers/suppliers, implementing new application fees, granting CMS authority to impose a temporary moratoria on enrollment, issuing guidelines about termination from Medicare if a provider is terminated by a Medicaid State agency, and establishing requirements for suspension of payments pending investigations of fraud. Comments on the final rule will be accepted by CMS until April 2.

Department of Health and Human Services, Centers for Medicare & Medicaid Services: Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Supplier, Final Rule with Comment Period, 76 Fed. Reg. 22, 5862, 5971 (Feb. 2, 2011).