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CMS Releases Final Rule to Address Fraud in Medicare and Medicaid

This week, CMS released a final rule, “Medicare, Medicaid, and Children's Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process,” to address fraud and other vulnerabilities in the CMS Medicare and Medicaid programs. The final rule creates a new authority that allows CMS to identify individuals and organizations that pose an undue risk of fraud, waste, or abuse based on their relationships with other previously sanctioned entities. Additionally, CMS can now block providers and suppliers who are revoked from re-entering the Medicare program for up to 10 years. Previously, revoked providers could only be prevented from re-enrolling for up to 3 years.

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