Bloomberg BNA's Health Care Fraud Report

Elizabeth Carder-Thompson and Jackie Godin’s article, “New CMS Enrollment and Revocation Regulations: Are We Charting the Unknown?” appeared in Bloomberg BNA’s Health Care Fraud Report on February 18th. The authors discuss the final rule, effective February 3rd, that gives the Centers for Medicare & Medicaid Services (CMS) an increased scope by which to deny or revoke a provider or supplier’s enrollment in Medicare. Under the new rule, CMS aims to limit the number of enrollees who are debtors (or had a previous ownership relationship with a debtor), convicted felons, or entities deemed as having a “pattern or practice” of billing for services that “do not meet Medicare requirements.” Elizabeth and Jackie commend the limitations on the first two groups as being “sensible,” while raising some concerns about the vague language used in the limitation of the latter group.