Improving health is our policy
Effective January 1, 2010, authorizes the Secretary of HHS to revoke a physician or supplier’s enrollment for up to a year for failure to maintain and provide (upon request) written orders or requests for payment or referrals of DME, home health services, and other items and services.
Prior to January 2013, CMS first effectuated provisions relating to this section in an interim final rule with comment released in May 2010, followed by a final rule in the fall of that year (regarding additional DMEPOS safeguards). In the spring of 2012, CMS issued a final rule pertaining to this provision (and others) that effectuates the interim final rule released in May 2010.
On May 8, 2014 the OIG issued a proposed rule delineating revisions to the OIG’s exclusion authority that aim to expand the agency’s fraud and abuse oversight of Federal health care programs. In particular, the regulation codifies statutory changes made by the Affordable Care Act (ACA) – including those delineated at sections 6402 (enhanced Medicare and Medicaid program integrity), 6406 (provider documentation), and 6408 (enhanced penalties) – that expand the OIG’s fraud and abuse oversight authorities. Finally, the regulation updates exclusion-related language pursuant to changes made by the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA). Additional information is available HHS here. Comments are due by July 8. Also, following the May 8 regulation, the OIG on May 9 issued a proposed rule that would incorporate new CMP authorities and make clarifying updates to associated regulations that stem from provisions of the ACA and Medicare Prescription Drug, Improvement and Modernization Act. Comments are due by July 11.
On July 27, CMS released a MLN Matters article titled, “Extension of Provider Enrollment Moratoria for Home Health Agencies and Part B Ambulance Suppliers.”
SEC. 6406. REQUIREMENT FOR PHYSICIANS TO PROVIDE DOCUMENTATION ON REFERRALS TO PROGRAMS AT HIGH RISK OF WASTE AND ABUSE. (a) PHYSICIANS AND OTHER SUPPLIERS.—Section 1842(h) of the Social Security Act (42 U.S.C. 1395u(h)) is amended by adding at the end the following new paragraph: ‘‘(9) The Secretary may revoke enrollment, for a period of not more than one year for each act, for a physician or supplier under section 1866(j) if such physician or supplier fails to maintain and, upon request of the Secretary, provide access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home health services, or referrals for other items or services written or ordered by such physician or supplier under this title, as specified by the Secretary.’’. (b) PROVIDERS OF SERVICES.—Section 1866(a)(1) of such Act (42 U.S.C. 1395cc) is further amended— (1) in subparagraph (U), by striking at the end ‘‘and’’; (2) in subparagraph (V), by striking the period at the end and adding ‘‘; and’’; and (3) by adding at the end the following new subparagraph: ‘‘(W) maintain and, upon request of the Secretary, provide access to documentation relating to written orders or requests for payment for durable medical equipment, certifications for home health services, or referrals for other items or services written or ordered by the provider under this title, as specified by the Secretary.’’. (c) OIG PERMISSIVE EXCLUSION AUTHORITY.—Section 1128(b)(11) of the Social Security Act (42 U.S.C. 1320a–7(b)(11)) is amended by inserting ‘‘, ordering, referring for furnishing, or certifying the need for’’ after ‘‘furnishing’’. (d) EFFECTIVE DATE.—The amendments made by this section shall apply to orders, certifications, and referrals made on or after January 1, 2010.
(202) 309-0796
Contact Us