Home Health & Hospice Week

Medicare is finally implementing procedures to go after providers that blatantly engage in fraud and abuse — but will non-fraudulent pro-viders get caught in the crossfire?

MACs will address so-called "recalcitrant" providers and suppliers with more aggressive tactics. The Centers for Medicare & Medicaid Services has learned from contractors that "some providers are abusing the Medicare program and not changing inappropriate behavior even after contractors provide them extensive education to address these behaviors," CMS says in a new MLN Matters article. "These noncompliant providers who refuse to comply with CMS rules, result in contractors’ placing these providers on prepay medical review and causing an administrative burden."

Change: "CMS is encouraging contractors to take advantage of current sanctions to address this problem of recalcitrant providers," the agency says. Contractors can use both civil money penalties and exclusion authority in these cases.

See an MLN Matters article on the topic, containing a link to the related CR, at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8394.pdf.