Health Law Matters

CMS Issues Final Rule on Federal Health Insurance Program Integrity

The Week In Health Law

  • The Centers for Medicare and Medicaid Services (“CMS”) issued a final rule  implementing additional program integrity requirements for health care providers participating in federal health insurance programs. The rule is aimed at preventing program participants from utilizing services of providers who have been suspended or face other “bad actor” issues, and to revoke provider enrollment in certain circumstances.
  • The rule will require Medicare, Medicaid, and Children's Health Insurance Program (“CHIP”) providers to disclose certain current and previous affiliations with providers and suppliers that have uncollected debt; have been or are subject to payment suspension under a federal health care program; have been or are excluded by the Department of Health and Human Services’ Office of Inspector General from Medicare, Medicaid, or CHIP; or had their Medicare, Medicaid, or CHIP billing privileges denied or revoked.
  • The rule gives CMS the ability to prevent applicants from enrolling in a federal health care program for up to three years if a provider or supplier is found to have submitted false or misleading information in its initial enrollment application. The rule also allows CMS to block providers and suppliers who are revoked from re-entering the Medicare program for up to ten years. Previously, revoked providers could be prevented from re-enrolling for only up to three years.
  • The content of such rules is not final until publication in the Federal Register. This rule is expected to be published on November 4.

More trending Health Law topics this week:

  • Doctor Relationships with Device Makers may be Ripe for Fraud Litigation

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Attorney Spotlight

Brian F. Higgins is an associate in FBT's regulated business group with a focus on health care, and he has a history as corporate counsel to Medpace, Inc., a pharmaceutical clinical research organization.