CMS Final Rule on Fraud Prevention Becomes Effective March 25, 2011

The Patient Protection and Affordable Care Act made a number of change to the Medicare, Medicaid and CHIP programs designed to combat fraud, waste and abuse. Effective March 25, 2011, various screening tools, including unannounced site visits and criminal background checks may become standard procedure when a provider or supplier enrolls or re-validates their participation in these programs. 

Providers will also be assessed an application fee (that will be used to fund the screening and integrity efforts) and undergo verification of licensure requirements as well as pre and post application examination of all enrollment criteria.

The new rule also authorizes CMS to impose moratoria on new provider enrollment to protect against fraud and authorizes the suspension of payments pending any investigation of a credible allegation of fraud.  Additionally, a State may rely on the results of the screening conducted by Medicare or other State Medicaid programs to fulfill the provider screening requirements under Medicaid and CHIP or may may also establish additional screening methods if they so desire.

More information on the specifics of the Final Rule can be found here:
http://edocket.access.gpo.gov/2011/pdf/2011-1686.pdf