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CMS Announces New Enforcement Authorities to Reduce Criminal Behavior

Posted on Monday, September 9, 2019 11:50 AM

This week, CMS issued a final rule that strengthens their ability to stop fraud before it occurs by keeping unscrupulous providers out of federal health programs.  This is a critical step forward in CMS’ longstanding fight to end “pay and chase” in federal healthcare fraud efforts and replaces it with proactive measures.

“The final rule, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC), creates several new revocation and denial authorities to bolster CMS’ efforts to stop waste, fraud and abuse. Importantly, a new “affiliations” authority in the rule allows CMS to identify individuals and organizations that pose an undue risk of fraud, waste or abuse based on their relationships with other previously sanctioned entities. For example, a currently enrolled or newly enrolling organization that has an owner/managing employee who is “affiliated” with another previously revoked organization can be denied enrollment in Medicare, Medicaid, and CHIP or, if already enrolled, can have its enrollment revoked because of the problematic affiliation. “

The new rule allows CMS to stop applicants from enrolling a program for three years if they have submitted false or misleading information in their application.  The new rule goes into effect on November 4, 2019.

Click here for the full press release.

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