Providers would be banned from Medicare and Medicaid if they fail to disclose that they are working with individuals who may be barred from billing the programs or who may owe money to the government, according to a new rule proposed by the CMS.
The rule (PDF), which also affects the Children's Health Insurance Program, was mandated under the Affordable Care Act. It also authorizes the CMS to deny or revoke a provider's or supplier's Medicare enrollment. It also increases Medicare program re-enrollment bans from three to 10 years.
If a provider or supplier attempts to get around a ban by teaming up with another party and billing through them, the CMS will add three more years to the provider's or supplier's ban. A second offense could mean the organization would be banned from Medicare for a maximum of 20 years.
If finalized, the rule would require a provider to be enrolled in Medicare in an approved status or have validly opted-out of the Medicare program before they can order, certify, refer or prescribe any Part A or B service, item or drug.
It will cost providers and suppliers more than $900 million to comply with the proposed rule over the first three years of its implementation once it's finalized, the CMS said. However, the agency had no data on the number of providers and suppliers that could be denied or revoked billing privileges under the rule. Comments on the rule are due by May 1.
The rule comes five months after the CMS began to enforce criminal background checks on providers considered at high risk for defrauding state Medicaid programs.
The CMS began conducting fingerprint-based background checks for Medicare providers in August 2014.
