CMS issues new fraud guidelines

The Centers for Medicare and Medicaid Services has issued stringent new rules regarding healthcare fraud, including ceasing payments whenever credible allegations are made, reports USA Today. In addition, more visits will be made to Medicare participants to prove they're legitimate contractors.

The new rules are designed to enhance the provider and supplier enrollment process for the nation's three leading health care programs--Medicare, Medicaid and CHIP--in an attempt to cut down fraud, waste and abuse. The rules would help federal health officials reduce an estimated $55 billion in fraudulent Medicare and Medicaid payments made each year, notes California Healthline.

"Our initiative will allow us to go beyond what we've always called 'pay and chase' and to actually have the tools and mechanisms to prevent much of the fraud we've seen in recent years," Peter Budetti, director of the CMS new anti-fraud office told USAToday.

Medical providers would be rated on their risk of engaging in fraud, and then classified as limited risk, moderate risk or high risk. Providers most likely to abuse the system will be subject to rigorous scrutiny, including fingerprinting and background checks.

The guidelines will published this week and subjected to a 60-day public comment period. Final regulations are expected by the end of the year.

For more:
- read the USAToday article
- read the California Healthline article
- check out the proposed rules