CMS Announces Fraud Protection Rule

The Centers for Medicare & Medicaid Services (CMS) has announced final rule aimed at preventing fraud in Medicare and is reportedly estimated to save taxpayers nearly $1.6 billion over 10 years.  The rule aims to ensure only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment and supplies for people with Medicare.  It also aims to help beneficiaries receive quality care with CMS verifying the credentials of a provider who is ordering or certifying equipment and supplies.

 “Thanks to the Affordable Care Act, we are expanding our work to combat fraud,” deputy administrator for program integrity Peter Budetti said in a statement.  “This rule will save money for taxpayers and ensure people with Medicare get high-quality care.”

The rule requires all providers and suppliers who qualify for a unique identification number - the National Provider (NPI) - include their NPI on applications to enroll in Medicare and medicaid and on all reimbursement claims submited.  This will aim to give CMS and States the ability to tie specific claims to the ordering or certifying physician or eligible professional and to check for suspiscious ordering activity. This rule builds on the work CMS is also doing in Medicare Part D by requiring that all prescriptions include an NPI for prescribing physicians. 

In conjunction with Part D, these efforts will aim to help better safeguard the Medicare Trust Funds by giving CMS the ability to know which providers are ordering, certifying and prescribing items and services to Medicare beneficiaries.