Eli's Hospice Insider

Published on Wed Nov 20, 2019 PDF

Certain name changes are on the list.

Under Medicare’s stepped-up efforts to root out fraudsters, it’s not only affiliation-related violations that can get you kicked from the Medicare program.

In its new program integrity rule on enrollment, the Centers for Medicare & Medicaid Services spells out four new actions on which it may base enrollment denials and revocations. A provider or supplier:

1. 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);

2. bills for services/items from noncompliant locations;

3. exhibits a pattern or practice of abusive ordering or certifying of Medicare Part A or Part B items, services or drugs; or

4. has an outstanding debt to CMS from an overpayment that was referred to the Treasury Department.

These new authorities will “improve CMS’ fraud-fighting capabilities,” the agency says in a release about the rule.