The U.S. Department of Health and Human Services has issued new rules to help fight waste, fraud and abuse in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). These important new tools were made possible by the Affordable Care Act, which includes a series of provisions to fight fraud in the health care system. The rules will strengthen and expand CMS’ fraud prevention efforts – stopping fraud on the front end by keeping out criminals who pose as providers and prey on Medicare, Medicaid, and CHIP, and saving the Medicare Trust Fund money by avoiding fraudulent claims.

Specifically, the proposed rule will:

• Establish the requirements for suspending payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
• Establish the authority for imposing a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries’ access to care.
• Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified  health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
• Outline requirements for states to terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
• Solicit input on how to best structure and develop provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements.

For more information click here.

Interested in what you can do to take action?  Check this out.  Click here.