Federal Anti-Fraud Rule Unveiled

Calls for Greater Scrutiny of Health Program Contractors
Federal Anti-Fraud Rule Unveiled
Federal regulators are seeking comments on a newly proposed rule designed to crack down against payment fraud for all federal health programs, including Medicare, Medicaid and the Children's Health Insurance Programs.

The proposal from the Centers for Medicare & Medicaid Services, which will be published in the Federal Register Sept. 23, pinpoints specific levels of screening for all federal health program contractors, including healthcare providers, to detect the risk of fraud.

Those considered "high risk" and subject to the most thorough screening would include newly enrolling home health agencies and suppliers of durable medical equipment. These organizations would be subject to unscheduled site visits, criminal background checks and fingerprinting, among other measures.

The proposed rule carries out provisions of the Obama Administration's massive healthcare reform package, including allowing the Department of Health and Human Services to suspend payment on claims connected to credible allegations of fraud until an investigation is complete.

The proposal also would give HHS the authority to impose a temporary moratorium on signing up new contractors in a region or a category if the agency detects patterns of fraud, waste or abuse.

Comments on the proposed rule CMS-6028-P, "Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers," will be accepted through Nov. 16. at regulations.gov.

About the Author

Howard Anderson

Howard Anderson

Former News Editor, ISMG

Anderson was news editor of Information Security Media Group and founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.

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