CMS Proposes Additional Incentives to Reduce Medicare Fraud Including Increase to Reward for Reporting Fraud


On April 24, 2013, CMS issued a proposed rule that would further incentivize Medicare beneficiaries and other individuals to report suspected Medicare fraud under the Medicare Incentive Reward Program.  CMS is proposing to increase the potential reward from 10 percent to 15 percent of the final amount collected, which could result in a reward of up to $9.9 million if CMS recovers $66 million or more.

CMS also sets forth new provider enrollment provisions in the proposed rule including, among others, the following:

  • Ability to deny the enrollment of providers, suppliers and owners affiliated with an entity that has unpaid Medicare debt;
  • Ability to deny enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses;
  • Ability to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements; and
  • Standardization of a consistent effective date of billing privileges across certain provider and supplier types (e.g., CMS proposes to eliminate ambulance suppliers’ current ability to bill retroactively up to one year prior to enrollment).

Over the last three years CMS has recovered more than $14.9 billion for alleged fraudulant activities, some of which is the result of individual reporting of suspected fraud.  The proposed rule is available here, and CMS’s fact sheet regarding the proposed rule is available here

Reporter, Juliet M. McBride, Houston, +1 713 276 7448,

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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