Under the proposed rules, to be published Thursday, CMS would:
* Suspend payments immediately after a “credible allegation” of fraud, including tips from consumers
* Require state Medicaid programs to stop using providers removed from Medicare, another Medicaid program or a CHIP program
* Visit more medical firms to ensure they are legitimate
* Rate types of medical providers by their risk for engaging in fraud
* Require fingerprinting and criminal background checks on providers with the highest risk
Initially, the increased scrutiny would be applied to new home-health agencies and home-health equipment suppliers that are not publicly traded. Medicare and Medicaid fraud prosecutions have netted $11 billion in fines and settlements since 1997.
Read the USA Today report on healthcare fraud.
Read more coverage on healthcare fraud:
– North Carolina Plans to Find More Medicaid Fraud With Electronic Reviews
– Top 10 Hospital Stories of 2010
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