CMS Announces New Enforcement Authorities to Reduce Criminal Behavior

September 11, 2019

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the agency’s ability to stop fraud before it happens by keeping unscrupulous providers out of federal health insurance programs. A new “affiliations” authority in the rule allows CMS to identify individuals and organizations that pose an undue risk of fraud, waste, or abuse based on their relationships with other previously sanctioned entities.

For example, a currently enrolled or newly enrolling organization that has an owner/managing employee who is “affiliated” with another previously revoked organization can be denied enrollment in Medicare, Medicaid, and CHIP or, if already enrolled, can have its enrollment revoked because of the problematic affiliation. Read a CMS press release
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