The new regulations specify that CMS can ban providers from Medicare under the following circumstances:
- CMS determines the physician or other professional has a pattern of prescribing Medicare Part D drugs that is abusive, threatens the health and safety of Medicare beneficiaries, or otherwise fails to meet Medicare requirements.
- The provider’s Drug Enforcement Administration Certificate of Registration has been suspended or revoked.
- The licensing or administrative body in any state in which the provider practices has suspended or revoked the provider’s ability to prescribe drugs.
This expanded authority will help protect beneficiaries from fraud, waste and abuse, according to CMS. The rule also makes other changes to Part D, such as requiring that Part D drug prescribers enroll in Medicare and expanding Part D data sharing. For more information, view a fact sheet on the rule here.
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