Thursday, April 26, 2012

CMS final rule aims to save $1.6B in fraud

This article was originally posted on

 The Centers for Medicare & Medicaid Services issued a final rule yesterday that requires stronger protections against fraudsters ordering and certifying medical services, supplies and services. 

The goal of the final rule is that only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment and supplies for Medicare beneficiaries, and CMS will verify provider credentials. Providers and suppliers still will need to include their National Provider Identifier number (NPI) when they apply for Medicare and Medicaid and when they submit claims for reimbursement. CMS and states can then tie specific claims to the ordering or certifying physician or eligible professional and check for suspicious activity, CMS said.

"Thanks to the Affordable Care Act, we are expanding our work to combat fraud," Deputy Administrator for Program Integrity Peter Budetti said in a statement yesterday. "This rule will save money for taxpayers and ensure people with Medicare get high-quality care."

Despite the critical eye of the Office of Inspector General on how well CMS is doing on actually combating fraud, CMS said it will save taxpayers nearly $1.6 billion over 10 years through anti-Medicare fraud efforts.

For more information:
- see the CMS announcement
- check out the final rule (.pdf)

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