CMS Strengthens Abuse Prevention Safeguards

The Centers for Medicare & Medicaid Services (CMS) is using new Affordable Care Act authority to combat fraud, waste, and abuse in the Medicare system. The agency announced new safeguards to strengthen provider oversight and protect taxpayer dollars from future abuse. The final rule will help prevent physicians and other providers with debt “from re-entering Medicare, remove providers with patterns or practices of abusive billing, and implement other provisions to help save more than $327 million annually,” according the December 3, 2014 press release.

The changes will allow CMS to:

• Deny enrollment to providers, suppliers, and owners affiliated with an entity that has Medicare debt; this will prevent people and entities that have incurred substantial Medicare debts from exiting the program and re-enrolling as a new business to avoid repayment of the outstanding Medicare debt.
• Deny or revoke the enrollment of a provider or supplier if a managing employee was convicted of a felony offense that CMS determines to be detrimental to Medicare patients. Recently implemented background checks will provide CMS with more information about felony convictions for high risk providers or suppliers.
• Revoke enrollments of providers and suppliers abusing billing privileges by demonstrating a pattern of billing services that do not meet Medicare requirements.

Read the final rule’s fact sheet for complete information.

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Michelle Dick

Executive Editor at AAPC

Michelle A. Dick has been executive editor for AAPC for over 10 years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. She has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.

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