CMS To Unveil Proposed Regulations To Combat Health Program Fraud

On Monday, CMS is scheduled to release proposed new regulations designed to address fraudulent activity and increase federal oversight of spending in the nation's three leading health care programs: Medicare, Medicaid and CHIP, USA Today reports. The new rules were mandated under the federal health reform law.

According to CMS officials, the new rules would give federal health officials more power to identify fraud early and help them reduce an estimated $55 billion in improper payments made annually through Medicare and Medicaid.

The new rules also would give CMS increased oversight on nearly $900 billion in annual spending on the three health care programs by allowing the agency to:

• Halt payments to providers if there is credible evidence or allegation of fraudulent activity, such a tips from consumers, which might warrant additional investigation;
• Require state Medicaid programs to end their associations with medical providers that have been eliminated from Medicare or another state's Medicaid or CHIP program;
• Conduct more site visits of participating medical firms to confirm their legitimacy; and
• Implement a rating system of all types of medical providers by their risk for engaging in fraud. Officials of firms deemed highest at risk would have to submit to fingerprinting and criminal background checks. New home-health agencies and suppliers of home-health equipment that do not have public trading status initially would require additional screening.

The proposed rules will be published on Thursday, which will launch a 60-day comment period. The final regulations are expected by the end of the year (Young, USA Today, 9/20).