Question:

What are the circumstances that the new CMS authorities may act on?

Answer:

The Centers for Medicare & Medicaid Services (CMS) states that “The rule also includes other authorities that will effectively improve CMS’ fraud-fighting capabilities. Similar to the affiliations component, these authorities provide a basis for administrative action to revoke or deny, as applicable, Medicare enrollment if:

  • A provider or supplier circumvents program rules by coming back into the program or attempting to come back in, under a different name (e.g. the provider attempts to “reinvent” itself)
  • A provider or supplier bills for services/items from non-compliant locations
  • A provider or supplier exhibits a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B items, services or drugs; or
  • A provider or supplier has an outstanding debt to CMS from an overpayment that was referred to the Treasury Department.”

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