The Occupational Safety and Health Administration (“OSHA”) has reopened the comment period on its June 2021 interim final rule establishing an Emergency Temporary Standard governing occupational exposure to COVID-19 in healthcare settings, codified at 29 C.F.R. § 1910 Subpart U (“Healthcare ETS”). While this reopening reaches certain questions and issues presented by OSHA and not … Continue Reading
The HHS Office of Inspector General (OIG) and the Government Accountability Office (GAO) have recently examined a number of Medicare and Medicaid provider screening and related program integrity issues. The OIG reports include the following:… Continue Reading
The House of Representatives has unanimously approved H.R. 3716, the Ensuring Access to Quality Medicaid Providers Act. The bill, which still awaits Senate consideration, would implement several OIG recommendations to improve CMS oversight of terminated providers and state screening of providers. Among other things, H.R. 3716 would require states and Medicaid managed care plans to … Continue Reading
On November 4, 2015, the House Energy and Commerce Health Subcommittee approved the following health policy bills: HR 2646, the Helping Families in Mental Health Crisis Act – includes a series of reforms intended to improve federal mental health research, screening, and treatment programs, some of which have met with strong opposition from House Democrats. … Continue Reading
According to the HHS Office of Inspector General (OIG), 12% of providers terminated for cause by a state Medicaid program in 2011 continued participating in other states’ Medicaid programs as of January 2014, despite an Affordable Care Act (ACA) requirement that states terminate any provider terminated for cause by another state Medicaid program. The OIG acknowledges … Continue Reading
The Government Accountability Office (GAO) has issued a report examining the extent to which CMS’s enrollment screening procedures are designed and implemented to prevent enrollment of ineligible or potentially fraudulent Medicare providers. The GAO identified weaknesses in CMS’s verification of provider practice location and physician licensure status that have allowed potentially ineligible providers and suppliers to … Continue Reading
A recent GAO review of Medicaid claims in four selected states (Arizona, Florida, Michigan, and New Jersey) discovered that thousands of Medicaid beneficiaries and hundreds of providers were involved in potentially improper or fraudulent payments during FY 2011. Such potentially improper payments involved, among other things, beneficiaries concurrently receiving benefits paid by two or more … Continue Reading
On June 1, 2015, CMS provided additional guidance to state Medicaid directors on implementation of fingerprint-based criminal background checks (FCBCs) as a component of ACA Medicare, Medicaid, and CHIP provider screening requirements. CMS stipulates that states have 60 days from the date of the letter to begin implementation of the FCBC requirement, and implementation must be … Continue Reading
A number of Congressional panels have held hearings this month on health policy issues, including the following: A House Ways and Means Committee hearing on Affordable Care Act implementation and the FY 2016 HHS budget request; A Senate Health, Education, Labor and Pensions (HELP) Committee hearing on “Health Information Exchange: A Path Towards Improving the … Continue Reading
According to the FY 2014 HCFAC program report, more than $3.3 billion was recovered in FY 2014 as a result of the government’s health care fraud judgments and settlements, including $2.3 billion won or negotiated by the federal government in FY 2014. Since the HCFAC program began in 1997, it has returned more than $27.8 … Continue Reading
CMS’s long-awaited fingerprint-based background check screening process is underway for certain “high-risk” providers and suppliers participating in federal health care programs (specifically, Medicare, Medicaid, and the Children’s Health Insurance Program). Under CMS regulations, individuals who maintain a 5 percent or greater direct or indirect ownership interest in a provider or supplier in the high risk category — … Continue Reading
By Elizabeth B. Carder-Thompson and Debra A. McCurdy on Posted in Other CMS Developments
More than three years after publication of final regulations to implement Affordable Care Act (ACA) provisions that strengthen provider and supplier enrollment screening provisions under federal health care programs, the Centers for Medicare & Medicaid Services (CMS) has selected a Fingerprint-Based Background Check Contractor and intends to phase in fingerprint-based background checks beginning in 2014.… Continue Reading
According to the latest Health Care Fraud and Abuse Control Program (HCFAC) Annual Report, federal health care fraud prevention and enforcement efforts resulted in the recovery of a record $4.3 billion in FY 2013, up from $4.2 billion in FY 2012. In announcing detailed enforcement achievements, the Administration cites new ACA authorities – including enhanced … Continue Reading
CMS has announced the redesign of the beneficiary Medicare Summary Notice (MSN) to enhance clarity and help seniors identify potential fraud, waste, and abuse. The MSN lists all services or supplies that providers and suppliers billed to Medicare during a 3-month period on behalf of the beneficiary, which CMS notes will help beneficiaries spot claims … Continue Reading
On February 11, 2013, the Obama Administration announced that anti-fraud efforts under the Health Care Fraud and Abuse Control Program (HCFAC) recovered a record-breaking amount of $4.2 billion in FY 2012. More specifically, in 2012 the Justice Department opened 1,131 new criminal health care fraud investigations involving 2,148 potential defendants, and a total of 826 … Continue Reading
On May 29, 2012, CMS published a notice announcing the launch of the “CMS Provider Screening Innovator Challenge,” a competition that aims to help the agency streamline operations, screen providers, and reduce fraud and abuse. The competition involves developing a multi-state, multi-program provider screening software application that would be capable of risk scoring, credentialing validation, … Continue Reading
The GAO has issued a report entitled “Medicare Program Integrity: CMS Continues Efforts to Strengthen the Screening of Providers and Suppliers.” The GAO describes how CMS and its contractors use provider and supplier enrollment information to prevent improper payments, along with factors that may affect the usefulness of this information. The report also provides an … Continue Reading
CMS has issued an informational bulletin that clarifies earlier guidance on section 6501 of the ACA, which establishes requirements for termination of provider participation under Medicaid if the provider is terminated under Medicare or other state plan. The new guidance clarifies that “for cause” terminations that are shared with other states should be limited to … Continue Reading
CMS will hold a National Provider Call on October 27, 2011 to discuss an ACA requirement that most Medicare-enrolled providers and suppliers revalidate their enrollment.… Continue Reading
