In 2011, CMS and HHS’ Office of the Inspector General issued a final rule to put into operation new screening procedures required by the Patient Protection and Affordable Care Act. As part of the implementation, CMS contracted with two new entities for healthcare provider screening purposes.
One of the new contractors is responsible for screening all healthcare providers enrolled to bill Medicare. The contractor ensures all providers are licensed, have a National Provider Identifier and have not previously been banned by the OIG from participating in the Medicare program. The second new contractor performs on-site visits at healthcare providers’ offices to ensure Medicare standards are being met, according to the report.
Since contracting with the new entities and implementing the PPACA screening requirements, CMS has banned 17,000 providers from billing the Medicare program, according to the report.
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