Medicare agency unveils new fraud prevention measures

Healthcare providers would be subject to new screening measures based on their level of risk to federal health programs, under new proposed regulations released by the Centers for Medicare and Medicaid Services. The fraud, waste and abuse prevention measures were called for in the new healthcare reform law. 

The screening measures include database and licensure checks, unscheduled or unannounced site visits, even criminal background checks and fingerprinting for the highest-risk providers and suppliers to Medicare, Medicaid and the Children's Health Insurance Program. The proposed rule, which will be open for comment for 60 days, also establishes the criteria for six-month enrollment moratoriums to combat fraud and on payment suspensions during pending fraud investigations. 

"These are important new tools that are provided by the Affordable Care Act that will help move from the pay-and-chase approach, the reactive approach that we've been using, to one that makes it harder to commit fraud in the first place," CMS Administrator Donald Berwick said during a conference call Monday. "The new tools we're proposing are going to give us the ability to stop fraud on the front-end, by keeping out unscrupulous people who pose as providers and prey on our beneficiaries and on our programs." 

Improper payments cost federal health programs about $55 billion a year. The White House piggy-backed off the announcement to make the case that defunding healthcare reform, as some Republicans in Congress are advocating, would increase fraud. "Opponents are threatening to defund the Affordable Care Act," Assistant to the President for Special Projects Stephanie Cutter writes on the White House blog, "which would effectively handicap implementation and enforcement of these new rules that would help crack down on criminals and protect seniors."