CMS rule targets Medicare fraud, should save $1.6B

April 24, 2012 in Medical Technology

WASHINGTON – The Centers for Medicare Medicaid Services (CMS) announced a final rule Tuesday aimed at preventing Medicare fraud. CMS estimates the rule will help save taxpayers nearly $1.6 billion over 10 years.

The rule ensures that only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment and supplies for people with Medicare. It also helps ensure beneficiaries receive quality care because CMS will verify the credentials of a provider who is ordering or certifying equipment and supplies.

[See also: Sebelius, Holder put spotlight on fight against Medicare fraud]

CMS has employed information technology and automated many of the tools for detecting and preventing fraud, aiding in implementing rules aimed at combating fraud and maintaining data security.

“Thanks to the Affordable Care Act, we are expanding our work to combat fraud,” said deputy administrator for program integrity Peter Budetti. “This rule will save money for taxpayers and ensure people with Medicare get high-quality care.”

In addition, the final rule continues to require that all providers and suppliers who qualify for a unique identification number – the National Provider Identifier (NPI) – include their NPI on applications to enroll in Medicare and Medicaid and on all reimbursement claims submitted. This gives CMS and states the ability to tie specific claims to the ordering or certifying physician or eligible professional and to check for suspicious ordering activity.

[See also: CMS awards $78M cybersecurity contract]

This rule builds on the work CMS is also doing in Medicare Part D by requiring all prescriptions include an NPI for prescribing physicians. In conjunction with Part D, these efforts will help better safeguard the Medicare Trust Funds by giving CMS the ability to know which providers are ordering, certifying and prescribing items and services to Medicare beneficiaries, CMS officials say.

[See also: CMS targets fraud with new analytics]

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