As the Affordable Care Act took effect this week, the Centers for Medicare and Medicaid Services unveiled a set of measures designed to prevent doctors from defrauding federal healthcare programs.
Provider and supplier abuse of Medicare, Medicaid and CHIP contributes to part of the $55 billion dollars per year that goes missing from federally funded healthcare programs. Congress and the Obama administration built increased oversight for the programs into the healthcare reform legislation.
The new regulations (PDF) proposed by CMS include screening measures for healthcare providers based on their level of risk to the system. Providers could be subject to database and licensure checks, unscheduled or unannounced site visits, criminal background checks and fingerprinting, depending on their level of risk. The proposed rules also establish the criteria for payment suspensions during investigations and for six-month enrollment moratoriums to fight fraud.
“The new tools we’re proposing are going to give us the ability to stop fraud on the front end, by keeping out unscrupulous people who pose as providers and prey on our beneficiaries and on our programs,” CMS administrator Dr. Donald Berwick said during a conference call today.
The proposals are open for public comment for 60 days.