CMS Administrator Seema Verma

Under a final rule issued Thursday, Centers for Medicare & Medicaid Services can deny or revoke Medicaid and Medicare program enrollment from providers and suppliers if an owner or manager is directly or indirectly affiliated with an organization that previously had its enrollment revoked.

The rule with comment period, which also applies to the Children’s Health Insurance Program, is effective Nov. 4. The measure is meant to identify individuals and organizations that are thought to pose an undue risk of fraud, waste or abuse based on their relationships with other previously sanctioned entities, according to CMS.

“Every dollar that is stolen from federal programs is a dollar that will never contribute to paying for an item or service for seniors and eligible people who need them,” CMS Administrator Seema Verma said in a statement. 

Providers and suppliers will be required to disclose their affiliation with any organization that:

  • Has uncollected debt;
  • Has been or is subject to payment suspension under a federal healthcare program;
  • Has been or is excluded from Medicaid, Medicare or CHIP by the Office of Inspector General; or 
  • Has had its Medicare, Medicaid or CHIP billing privileges denied or revoked.

CMS first proposed the rule in March 2016.

“For too many years, we have played an expensive and inefficient game of ‘whack-a-mole’ with criminals — going after them one at a time — as they steal from our programs,” Verma said. “These fraudsters temporarily disappear into complex, hard-to-track webs of criminal entities and then re-emerge under different corporate names. These criminals engage in the same behaviors again and again. Now, for the first time, we have tools to stop criminals before they can steal from taxpayers.” 

The final rule, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC), is scheduled to be published in the Federal Register on Sept. 10 but is available as a 269-page PDF now.