CMS’ new rules will deny enrollment to “bad apple” providers

December 9, 2014

Providers, owners and suppliers who owe Medicare money, have been convicted of felonies or have a history of billing abuse will be excluded from enrollment under new rules adopted by the Centers for Medicare and Medicaid Services (CMS).

Providers, owners and suppliers who owe Medicare money, have been convicted of felonies or have a history of billing abuse will be excluded from enrollment under new rules adopted by the Centers for Medicare and Medicaid Services (CMS)

The move will save about $327 million annually, according to CMS. 

“The changes announced today are common-sense safeguards to preserve Medicare for generations to come, while making the rules more consistent for all providers that work with us,” said CMS Administrator Marilyn Tavenner. “The Administration is committed to using all appropriate tools as part of its comprehensive program integrity strategy shaped by the Affordable Care Act.”

CMS Deputy Administrator and Director of the Center for Program Integrity, Shantanu Agrawal, M.D., said, “CMS has removed nearly 25,000 providers from Medicare and the new rules help us stop bad actors from coming back in as we continue to protect our patients. For years, some providers tried to game the system and dodge rules to get Medicare dollars; today, this final rule makes it much harder for bad actors that were removed from the program to come back in.”

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Health care providers that are denied enrollment are prohibited from getting reimbursed for services provided to Medicare beneficiaries.

The new rules will also standardize billing dates.  Ambulance suppliers will no longer be allowed to bill Medicare for up to a year prior to enrollment. In addition, they will now be required to submit claims within 60 days if their enrollment is revoked.

View the rule changes here.