CMS Issues Proposed Rule Addressing Enhanced Program Integrity Requirements

The Centers for Medicare & Medicaid Services (CMS) has taken another important step in its efforts to prevent and detect fraud with its publication of a Proposed Rule addressing program integrity changes mandated by the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act, or the ACA). Among other things, the Proposed Rule would enhance background screening procedures for providers and suppliers participating orenrolling in the Medicare and Medicaid programs as well as the Children’s Health Insurance Program (CHIP). These changes are consistent with the five-principle strategy adopted by the Office of Inspector General for the Department of Health and Human Services (OIG) to fight health care fraud, waste, and abuse. Both the OIG and CMS are emphasizing the need to more closely scrutinize individuals and entities seeking to participate in Medicare, Medicaid, and other federal health care programs as well as those revalidating enrollment.

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