The US Department of Health and Human Services (HHS) has released the final rule with comment period that will implement new provider screening and enforcement measures aimed at reducing fraudulent providers and suppliers from enrolling in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). The final rule also grants these federal programs authority to suspend payments when a credible allegation of fraud is being investigated.

As the federal government continues the process of implementing the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010 (known collectively as the Affordable Care Act), APTA will provide a snapshot of the regulations and other items of importance to physical therapy. Screening and Enrollment Final Rule Aimed at Preventing Fraud: The US Department of Health and Human Services (HHS) has released the final rule with comment period that will implement new provider screening and enforcement measures aimed at reducing fraudulent providers and suppliers from enrolling in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). The final rule also grants these federal programs authority to suspend payments when a credible allegation of fraud is being investigated. The final rule: * Creates a rigorous screening process for providers and suppliers enrolling in Medicare, Medicaid, and CHIP that have been identified in the past as posing a higher risk of fraud, for example durable medical equipment suppliers. * Requires new enrollment processes for Medicaid and CHIP providers. States will have to screen providers who order and refer to Medicaid beneficiaries. Providers who have been excluded from Medicare or any state's Medicaid or CHIP program will be barred from all Medicaid and CHIP programs. * Temporarily stops enrollment of new providers and suppliers if a trend is identified in a category of providers or geographic area, as long as patients' access to care will not be affected. * Temporarily stops payments to providers and suppliers in cases of suspected fraud. A copy of the regulation is on display at the Federal Register and may be downloaded at www.ofr.gov/inspection.aspx. More information can be found at www.HealthCare.gov, an HHS Web portal. HHS also released a report this week on record-high fraud recovery efforts for fiscal year 2010. Read more and access the report in today's News Now article "DOJ and HHS Fraud Efforts Recover Record Amount in FY 2010." APTA is carefully analyzing all of the implementing regulations related to health care reform to determine their impact on physical therapy. To learn more about these and other regulations related to health care reform, visit APTA's Web site.

Source: PT IN MOTION

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