Home Health & Hospice

More New Rules to Fight Fraud

Homecare Insider, February 14, 2011

On January 24, 2011, new rules were announced under the Affordable Care Act (ACA) that will help fight fraud in the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) programs while protecting patients and legitimate providers. These new rules are said to provide more proactive fraud prevention and give the Department of Health and Human Services new enforcement tools.

The new rules will: create a rigorous screening process for providers and suppliers enrolling in these programs in order to keep fraudulent providers out and subject all enrolling providers to a more thorough screening process. They would require a new enrollment process for Medicaid and CHIP providers to allow states to screen providers for a history of fraud, temporarily stop enrollment of new providers and suppliers within a geographic area that has been identified as high risk-as long as it won’t impact access of care for patients, and temporarily stop payments to providers and suppliers that are suspected of fraud while action or investigation is in progress. In 2010, the government’s health care fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars.

The ACA also provides an additional $350 million to anti-fraud efforts, requires data sharing to fight fraud, enhances penalties to deter fraud and abuse, increases sentencing guidelines for healthcare fraud offenses, and provides enhanced tools and authorities for greater oversight of private insurance abuses.

The Centers for Medicare and Medicaid Services will take public comments on limited areas of this final rule for 60 days. To learn more, read a fact sheet about the new rules.