Summary of the New CMS Proposed Rule on Medicare Revocations and Enrollment Denials

The Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that expands and enhances their authority to (A) deny enrollment, or (B) revoke Medicare billing privileges for healthcare providers and suppliers. The proposed rule would change Medicare enrollment, revocations, and overpayment settlements.

Some key points of the proposed rule include:

1. Misdemeanor Convictions: If a provider or supplier (including any relevant personnel), has been convicted of a misdemeanor under Federal or State law within the past 10 years, their enrollment application may be denied, or existing enrollment revoked.
2. False Claims Act Judgments: CMS could revoke or deny enrollment if a provider or supplier had a civil judgment imposed against them within the previous 10 years.
3. Violation of Provider and Supplier Standards: Enrollment could also be denied or revoked if a provider or supplier violates certain standards, such as maintaining liability coverage, soliciting patients, and customer service requirements.

Additionally, CMS is proposing a “60-day stay of enrollment” as an intermediate step before revoking or deactivating billing privileges. During this period, the provider or supplier would not receive payment for services or items furnished.

Recommendations for Health Care Companies:

1. Review Personnel Backgrounds: Health care companies should carefully screen the backgrounds of their owners, managing employees, officers, directors, and any other relevant personnel to ensure there are no misdemeanor convictions that could lead to enrollment denials or revocations.
2. Monitor Compliance with Provider Standards: Companies should strictly adhere to provider and supplier standards set by CMS, including liability coverage, patient solicitation, and customer service requirements, to avoid potential enrollment issues.
3. Be Prepared for Reporting: Companies must be ready to submit appropriate enrollment reports if CMS identifies non-compliance during the proposed “60-day stay of enrollment” to avoid further consequences.
4. Stay Informed: Health care companies should closely monitor updates and developments related to the proposed rule and promptly submit any comments or feedback to CMS.
5. Seek Legal Advice: The rule is complex and the consequences for violations are harsh. We strongly recommend seeking legal advice from an experienced health care law firm that specializes in Medicare enrollment and enforcement actions, like Hamill Little. We can help navigate and address any issues you may face.

If you have questions or would like to speak with a lawyer regarding enrollment or other enforcement actions, please contact us at (404) 685-1662 (Atlanta), or (706) 722-7886 (Augusta), or at info@hamillittle.com. See more at hamillittle.com.

 

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