dockets: CMS-2013-0080

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id agency_id title docket_type last_modified object_id rin dkabstract category subtype keywords program short_title effective_date organization attrs_raw attr_source
CMS-2013-0080 CMS Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment (CMS-6045-P) Rulemaking 2021-04-21T01:00:50Z 0b000064812ac0be 0938-AP01 This proposed rule would revise the Incentive Reward Program provisions in § 420.405 and certain provider enrollment requirements in part 424, subpart P. The most significant of these revisions include: changing the Incentive Reward Program potential reward amount for information on individuals and entities who are or have engaged in acts or omissions which resulted in the imposition of a sanction from 10 percent of the overpayments recovered in the case or $1,000, whichever is less, to 15 percent of the final amount collected applied to the first $66,000,000 for the sanctionable conduct; expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier’s enrollment; if certain criteria are met, enabling us to deny enrollment if the enrolling provider, supplier, or owner thereof had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling us to revoke Medicare billing privileges if we determine that the provider or supplier has a pattern or practice of submitting claims for services that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to ‘‘backbill’’ for services performed prior to enrollment. We believe this proposed rule would—increase the incentive for individuals to report information on individuals and entities that have or are engaged in sanctionable conduct; improve our ability to detect new fraud schemes; and help us ensure that fraudulent entities and individuals do not enroll in or maintain their enrollment in the Medicare program.               {"displayProperties": [], "keywords": null, "modifyDate": "2021-04-21T01:00:50Z", "dkAbstract": "This proposed rule would\r\nrevise the Incentive Reward Program\r\nprovisions in \u00a7 420.405 and certain\r\nprovider enrollment requirements in\r\npart 424, subpart P. The most significant of these revisions include: changing the\r\nIncentive Reward Program potential\r\nreward amount for information on\r\nindividuals and entities who are or have\r\nengaged in acts or omissions which\r\nresulted in the imposition of a sanction\r\nfrom 10 percent of the overpayments\r\nrecovered in the case or $1,000,\r\nwhichever is less, to 15 percent of the\r\nfinal amount collected applied to the\r\nfirst $66,000,000 for the sanctionable\r\nconduct; expanding the instances in\r\nwhich a felony conviction can serve as\r\na basis for denial or revocation of a\r\nprovider or supplier\u2019s enrollment; if\r\ncertain criteria are met, enabling us to\r\ndeny enrollment if the enrolling\r\nprovider, supplier, or owner thereof had\r\nan ownership relationship with a\r\npreviously enrolled provider or supplier\r\nthat had a Medicare debt; enabling us to revoke Medicare billing privileges if we\r\ndetermine that the provider or supplier\r\nhas a pattern or practice of submitting\r\nclaims for services that fail to meet\r\nMedicare requirements; and limiting the\r\nability of ambulance suppliers to\r\n\u2018\u2018backbill\u2019\u2019 for services performed prior\r\nto enrollment. We believe this proposed\r\nrule would\u2014increase the incentive for\r\nindividuals to report information on\r\nindividuals and entities that have or are\r\nengaged in sanctionable conduct;\r\nimprove our ability to detect new fraud\r\nschemes; and help us ensure that\r\nfraudulent entities and individuals do\r\nnot enroll in or maintain their\r\nenrollment in the Medicare program.", "agencyId": "CMS", "program": null, "shortTitle": null, "subType2": null, "title": "Medicare Program; Requirements for\r\nthe Medicare Incentive Reward\r\nProgram and Provider Enrollment (CMS-6045-P)", "generic": null, "field1": null, "docketType": "Rulemaking", "petitionNbr": null, "rin": "0938-AP01", "organization": null, "legacyId": null, "subType": null, "category": null, "field2": null, "effectiveDate": null, "objectId": "0b000064812ac0be"} single_get

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