United States: Proposed CMS Rule Requires Providers To Disclose Affiliations

On March 1, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that amends regulations under 42 CFR 405, 424, 455 and 457 to require Medicare, Medicaid and CHIP providers and suppliers to disclose any current or previous affiliation with a provider or supplier that (i) has uncollected debt; (ii) has been or is subject to a payment suspension under a federal health care program; (iii) has been excluded from Medicare, Medicaid or CHIP; or (iv) has had its Medicare, Medicaid or CHIP billing privileges denied or revoked.

The proposed rule allows CMS to deny and revoke provider and supplier enrollment based on affiliations that pose an undue risk of waste, fraud and abuse. The rule also increases the Medicare program re-enrollment ban from three to 10 years. Any attempt to circumvent a ban can result in the ban being extended for up to 20 years.

Comments on the proposed rule are due by May 2, 2016.

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