Chairman Carper, Ranking Member Coburn Highlight New Agency Rules to Curb Medicare Waste, Fraud, and Abuse

WASHINGTON- The Centers for Medicare and Medicaid Services (CMS) recently announced new rules that will enhance oversight on Medicare in an effort to curb waste, fraud and abuse. The announcement comes after Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.) and Ranking Member Tom Coburn (R-Okla.) wrote a letter to CMS urging stronger action to screen and remove Medicare providers who are convicted of felonies that should result in exclusion from the program. Today’s new rules, which mirror measures previously introduced by the Senators, would address the concerns raised in their letter.

“This announcement from the Centers for Medicare and Medicaid (CMS) demonstrates that officials are taking important steps to eliminate waste, fraud and abuse in Medicare,” said Chairman Carper. “Millions of Americans rely on Medicare for quality health care. But every year, this vital program loses billions of taxpayer dollars to errors and criminal activity. These new authorities will allow CMS to stop wasteful and fraudulent payments before they are made and help preserve the program for years to come. I commend CMS for taking action and for its renewed commitment to curb waste, fraud and abuse. I will continue to work with my colleagues in the Senate and the Administration to fortify the integrity of our Medicare and Medicaid programs.”

“CMS has taken another positive step forward in better protecting the Medicare program from providers and suppliers who are abusing the system,” said Ranking Member Coburn. “Deadbeat doctors and felons should have no place in treating beneficiaries or receiving federal payments.  It is my hope CMS continues to identify and implement commonsense tools to shore up the integrity and service of Medicare.”

According to CMS, the new authorities will:

  • Deny enrollment to providers, suppliers and owners affiliated with any entity that has unpaid Medicare debt. This will prevent people and entities that have incurred substantial Medicare debts from exiting the program and then attempting to re-enroll as a new business to avoid repayment of the outstanding Medicare debt.
  • Deny or revoke the enrollment of a provider or supplier if a managing employee has been convicted of a felony offense that CMS determines to be detrimental to Medicare beneficiaries. The recently implemented background checks will provide CMS with more information about felony convictions for high-risk providers or suppliers.
  • Revoke enrollment of providers and suppliers engaging in abuse of billing privileges by demonstrating a pattern or practice of billing for services that do not meet Medicare requirements.