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New rules make it harder to cheat Medicare

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New regulations aimed at curbing fraud related to the Medicare and Medicaid programs, which amounts to $55 billion annually, have just been revealed.

The new regulations include immediately suspending payments to providers when a “credible allegation” of fraud is made, including tips from consumers; requiring state Medicaid programs to refuse providers who have been rejected by Medicare or another state’s Medicaid or Children’s Health Insurance Program; physically auditing providers’ places of business to ensure they are legitimate; and ranking providers according to their risk of engaging in fraudulent behavior and fingerprinting them and conducting background checks on the riskiest.

Privately owned homecare agencies and equipment providers wishing to join the ranks of Medicare-reimbursement recipients would be subject to fingerprinting and background checks as well.

Peter Budetti, the new anti-fraud director at the Centers for Medicare and Medicaid Services, said in an interview with USA Today, “Our initiative will allow us to go beyond what we’ve always called ‘pay and chase’ and to actually have the tools and mechanisms to prevent much of the fraud we’ve seen in recent years.”


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