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Payment Matters
October 7, 2010
Increased Scrutiny to Obtain and Maintain Medicare and Medicaid Enrollment – Time to Comment is Now
By: Donna J. Senft
Several provisions in the recent health care reform legislation were designed to enhance the Medicare and Medicaid enrollment procedures to protect against fraud by prohibiting unqualified individuals and entities from obtaining or maintaining enrollment. Proposed regulations "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" [PDF] were published on September 23, 2010, with a 60-day comment period ending November 16, 2010. The following discussion provides a glimpse into some of the key provisions in the proposed regulation changes. There are specific rules related to Medicare enrollment as well as rules that state Medicaid programs would be required to implement to get federal financial participation funding.
Provider and Supplier Screening
CMS has identified three categories that will guide enrollment screening based upon "CMS' assessment of fraud, waste and abuse risk of the provider or supplier category." Tables [PDF] are included that list the proposed provider and supplier types that are identified as "limited," "moderate," or "high" risk, with CMS requesting comments on the provider and supplier types in each category.
Click to continue...OIG Publishes FY 2011 Work Plan
The OIG published is FY 2011 Work Plan, which is posted on the OIG website at www.oig.hhs.gov/publications/workplan/2011/FY11_WorkPlan-All [PDF]. The Plan provides brief descriptions of the areas in which the OIG intends to continue or initiate examination in the federal fiscal year 2011, which began on October 1, 2010. The areas of OIG's inquiry include Parts A, B, C and D of the Medicare Program, as well as inquiry into areas of the Medicaid Program. The OIG also posts reports of the audits it conducts pursuant to the Plan, on its website.
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