HHS issues proposed rule to stem Medicare, Medicaid, and CHIP fraud

Posted on September 21, 2010 | No Comments
Filed under Centers for Medicare & Medicaid Services, Department of Health and Human Services, Fraud and Abuse, Key Developments, Medicaid and CHIP, Medicare

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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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