On Thursday, September 23, 2010, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule outlining how it intends to implement several of the new anti-fraud measures called for under PPACA. According to CMS Administrator Donald Berwick, these measures are part of the government’s efforts to take a proactive approach to fraud prevention, by preventing improper payments before they are made as opposed to seeking to recoup monies improperly paid. The proposed rule addresses the following measures:
- Screening for new providers and suppliers, including licensure checks, database checks, unannounced site visits, and, for “high risk” entities such as certain home health providers and durable medical equipment suppliers, criminal background checks;
- $500 application fee for institutional providers;
- Six-month moratorium on enrollment where necessary; and
- Suspension of payments pending “credible” allegations of fraud, which could include complaints to CMS, the Department of Health and Human Services Office of Inspector General, or other law enforcement.
Under PPACA, these new measures are scheduled to take effect March 23, 2011, and will apply to new provider and supplier applicants, as well as renewal applicants. CMS is accepting comments on the proposed rule through November 16, 2010.