On February 22, 2016, CMS announced on its blog four new enrollment tactics designed to strengthen provider enrollment screening efforts.  Just three days later, on February 25, 2016, CMS released a proposed rule that would implement sections of the Affordable Care Act geared toward ensuring that individuals and entities that pose risks to the Medicare program and beneficiaries are kept out of the program or are removed for extended periods of time. 

Among other things, the Proposed Rule would require providers and suppliers to disclose current affiliations or previous affiliations within the past five years, whether direct or indirect, with any provider or supplier that: (i) currently has uncollected debt to Medicare, Medicaid or CHIP; (ii) has been or is subject to a payment suspension; (iii) has been excluded from Medicare, Medicaid or CHIP; or (iv) has had its Medicare, Medicaid or CHIP billing privileges denied or revoked.

CMS would have the authority to deny or revoke Medicare enrollment for any providers or suppliers that it determines are revoked under a different name, numerical identifier or business entity, and would also have the authority to revoke a physician’s or eligible professional’s Medicare enrollment if the physician or eligible professional has a pattern of ordering, certifying, referring or prescribing Medicare Part A or B services, items or drugs that is abusive, poses a threat to beneficiaries or otherwise fails to meet Medicare requirements.  The Proposed Rule would increase the re-enrollment ban from three years to ten years.  The Proposed Rule is scheduled to be published in the Federal Register on March 1, 2016.  For a public inspection copy of the Proposed Rule, please click here.  For a CMS fact sheet on the Proposed Rule, please click here.  Comments on the Proposed Rule are due by May 1, 2016.  

The Proposed Rule follows an announcement on CMS’s blog on February 22, 2016.  CMS’s additional provider screening tactics announced on its blog include the following:  (i) increasing the number of site visits conducted for Medicare enrolled providers and suppliers; (ii) replacing the current PECOS address verification software with Delivery Point Verification (DPV) to detect addresses that are vacant, invalid or commercial mail reporting agencies; (iii) beginning in March 2016, routinely deactivating providers that have not billed Medicare within the past 13 months; and (iv) routinely checking potentially invalid addresses against the United States Postal Service address verification database.  The announcement follows a recent Government Accountability Office (GAO) report, which identified areas for improvement in CMS’s verification of provider and supplier practice locations. 

Reporters, Kate Stern, Atlanta, +1 404 572 4661, kstern@kslaw.com and Kerrie S. Howze, Atlanta, +1 404 572 3594, khowze@kslaw.com.