Medicare Compliance & Reimbursement

Medicare beneficiaries will likely pay a price, too.

The items you report when you enroll or reenroll in Medicare could change drastically if the Centers for Medicare & Medicaid Services’ (CMS’) proposed rule, published in the March 1 Federal Register, is finalized. The agency also wants greater authority to revoke provider enrollment in a number of new circumstances.

These newly proposed fraud-fighting provisions in Medicare’s proposed rule for enrollment changes will actually mostly harm legitimate providers trying to comply, said many of the organizations that submitted 56 comment letters on the rule.

“As with most other compliance requirements, particularly those that require voluntary disclosure, the true criminals in our midst will simply lie — and in a very convincing way,” said the Illinois Home Care & Hospice Council in its comment letter. “As a result, the primary burden of these new requirements will be borne by compliance-oriented agencies.”

“Medicare providers can be forced to incur unnecessary costs to comply with a new rule and respond to a new integrity effort when a broad-based action is taken to address the abusive, but isolated conduct of a few providers,” pointed out the National Association for Home Care & Hospice (NAHC) in its comments.

“The proposed rule would be overly burdensome on providers due to its numerous requirements,” agreed the American Physical Therapy Association (APTA) in its comment letter. “Innocent providers and suppliers will be unduly penalized because the costs associated with compliance are too high.”

“The United States’ health care system is already very complex and difficult to access,” said the Texas Association for Home Care & Hospice in its comment letter. “We are concerned that the complexity of the proposed expanded reporting requirements on affiliations will make an already burdensome system even more difficult to navigate.”

And providers aren’t the only ones harmed by overly broad fraud-fighting programs. “Random, untargeted program integrity measures can bring harm to Medicare beneficiaries and all other stakeholders,” NAHC told CMS. “For example, a measure could raise barriers to access to timely care for beneficiaries duly entitled to coverage.”

Instead: “CMS could use its data mining capabilities more effectively to capture the necessary information instead of creating additional reporting requirements for providers,” countered Kindred Healthcare in its comment letter.

“The Medicare program will be better served if CMS adopts a rule that is much more targeted in identifying and weeding out possible bad actors,” APTA recommended.

CMS should focus on new entrants, NAHC urged. “Abusers of the Medicare program generally do not evolve into abusers over time,” the trade group argued. “Instead, it can be expected that they come into Medicare with original intent to commit fraud. As such, program integrity measures that prevent such providers from entering into Medicare should be considered and implemented as a priority approach.”