Fraud and Abuse
HHS issues proposed rule to stem Medicare, Medicaid, and CHIP fraud
Posted on September 21, 2010
The Department of Health and Human Services has issued a proposed rule to stem fraud in the Medicare, Medicaid, and Children’s Health Insurance Program under authority created by the health reform law.
According to the agency, the proposed rule will:
- “Establish the requirements for suspending payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
- “Establish the authority for imposing a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries’ access to care.
- “Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
- “Outline requirements for states to terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
- “Solicit input on how to best structure and develop provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements.”
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HHS releases final rules for achieving ‘Meaningful Use’ of electronic records
Posted on July 15, 2010
The Department of Health and Human Services announced final rules for achieving “meaningful use”of electronic health records so that eligible physicians and hospitals may qualify for as much as $27 billion in federal funding.
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CMS proposes rule on nursing home civil monetary penalties
Posted on July 13, 2010
The Centers for Medicare and Medicaid Services has proposed a rule that will govern civil monetary penalties on nursing homes under the health reform law. CMS is empowered to place fines collected in an escrow account, which will be returned with interest if a nursing home successfully appeals.
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Health agencies launch fraud prevention education campaign
Posted on June 8, 2010
The Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Administration on Aging have launched a one million-dollar public-education campaign to combat fraud timed to coincide with the issuing of $250 “donut hole rebate” checks created by the health reform law. This includes radio ads in English, Spanish, Korean, and Armenian.
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HHS and DOJ send letter to combat Medicare fraud
Posted on June 8, 2010
Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder have sent a letter to state attorneys general on new efforts to combat Medicare fraud. The letter is timed to coincide with the mailing of the $250 “donut hole rebate checks” authorized by the health reform law and pledges to “use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”
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Fraud and Abuse: Revisions to Anti-Kickback Statute
Posted on May 20, 2010
The health reform law revises the anti-kickback statute to broaden the reach of the law and enhance enforcement.
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HHS & DOJ highlight new anti-fraud provisions in health reform law
Posted on May 13, 2010
Releasing an annual report on health care fraud prevention, the Department of Health and Human Services and the Department of Justice emphasize new measures of the health reform law designed to route out abuse of the system.
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