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CMS proposes new Medicare enrollment restrictions, incentives to reduce fraud

April 24, 2013

The Centers for Medicare & Medicaid Services today issued a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the recovery of funds. In addition, the rule would allow the agency to deny Medicare enrollment to providers affiliated with an entity that has unpaid Medicare debt; deny enrollment or revoke billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses; and revoke billing privileges for providers and suppliers who “have a pattern or practice of billing for services that do not meet Medicare requirements,” CMS said. The proposed rule will be published in the April 29 Federal Register with comments accepted for 60 days. In addition, the Department of Health and Human Services’ Administration for Community Living this month announced up to $7.3 million in funding to expand Senior Medicare Patrol activities. Each of the current 54 SMP projects is eligible for varying funding levels, up to a total of $7.3 million across the program, CMS said.