On December 3, 2014, the Centers for Medicare & Medicaid Services (CMS) released a Final Rule that provides CMS discretion to deny or revoke Medicare enrollment based on certain circumstances. The changes in the Final Rule allow CMS to:

• Deny enrollment to providers, suppliers and owners affiliated with any entity that has unpaid Medicare debt; this will prevent people and entities that have incurred substantial Medicare debts from exiting the program and then attempting to re-enroll as a new business to avoid repayment of the outstanding Medicare debt.
• Deny or revoke the enrollment of a provider or supplier if a managing employee has been convicted of a felony offense that CMS determines to be detrimental to Medicare beneficiaries. The recently implemented background checks will provide CMS with more information about felony convictions for high risk providers or suppliers.
• Revoke enrollments of providers and suppliers engaging in abuse of billing privileges by demonstrating a pattern or practice of billing for services that do not meet Medicare requirements.

A fact sheet about the Enrollment Final Rule is available on the CMS website: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-12-03.html

A copy of the Enrollment Final Rule is also available on the CMS website at: https://www.federalregister.gov/public-inspection

Written by: Clay J. Countryman