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Medicare Is Simple
Friday, July 29, 2016
CMS extends, expands fraud-fighting enrollment moratoria efforts in six states
CMS extends, expands fraud-fighting enrollment
moratoria efforts in six states New demonstration enhances agency’s
enrollment and investigative options
Today, the Centers for Medicare
& Medicaid Services (CMS) announced an extension and statewide expansion of
fraud-fighting temporary provider enrollment moratoria efforts in six states,
along with a new related demonstration project to allow for certain exceptions
to the moratoria and heightened screening requirements for new providers.
CMS also announced it is immediately lifting the current temporary
moratoria on all Medicare Part B, Medicaid, and Children’s Health Insurance
Program (CHIP) emergency ground ambulance suppliers.
“CMS is continuing its efforts to
tackle fraud, waste, abuse and protect benefits and services for those eligible
for federal health care programs through expanding the existing temporary
moratoria,” said Shantanu Agrawal, M.D., deputy administrator for program
integrity, CMS. “CMS is also increasing its oversight efforts through the use
of heightened screening and investigative tools for new providers in the
CMS announced it is extending for
six months and expanding statewide the temporary provider enrollment moratoria
on new Medicare Part B non‑emergency ground ambulance suppliers in New Jersey,
Pennsylvania, and Texas and home health agencies (HHAs) in Florida, Texas,
Illinois, and Michigan. Additionally, the statewide expansion also
applies to Medicaid and CHIP. CMS also announced the Provider Enrollment
Moratoria Access Waiver Demonstration(PEWD), which gives CMS the
ability to allow for provider and supplier enrollment exceptions in the
moratoria areas if access to care issues are identified and for the development
and improvement of methods of investigating and prosecuting fraud in Medicare,
Medicaid, and CHIP.
The statewide expansion of the
temporary moratoria coupled with the PEWD will allow CMS to continue to target
fraud within these services while granting individual enrollment waivers.
These changes will address access to care issues and allow providers and
suppliers who are subject to the moratoria to enroll in Medicare, Medicaid, and
CHIP after passing heightened screening requirements. The agency will
also immediately lift the current temporary moratoria on all Medicare Part B,
Medicaid and CHIP emergency ground ambulance suppliers. These changes are
effective on July 29, 2016.
CMS’ key responsibilities is to
protect the Trust Funds and other public resources against losses from fraud,
waste, abuse, and other improper payments and to improve the integrity of the
federal health care system. CMS’s program integrity strategy is moving
beyond the reactive “pay and chase” method toward a more effective, proactive
strategy that identifies potential improper payments before they are made,
keeps unscrupulous providers and suppliers out of Medicare and Medicaid at the
outset, quickly removes wrongdoers from the programs once they are detected,
and corrects improper payments as quickly as possible.
Moratoria and related
investigations are a portion of CMS’ comprehensive strategy, the results of
which are demonstrated our recently published activities in FY 2013 and FY
2014. CMS estimates that program integrity activities saved Medicare
$21.1 billion in FY 2013 and $18.1 billion in FY 2014, for a two-year return on
investment of $12.4 to 1.