The Centers for Medicare & Medicaid Services (CMS) proposed a new rule to strengthen its ability to recover improper payments and remove noncompliant providers and suppliers from Medicare. Although included in the Calendar Year (CY) 2027 Home Health PPS proposed rule, the provider enrollment provisions would apply across Medicare provider and supplier types. Comments on the proposed rule are being accepted through August 31.
Currently, CMS can claw back payments retroactive to the date of noncompliance for certain Medicare provider enrollment revocation grounds. The proposed rule would make this possible for all Medicare provider enrollment revocations, regardless of the revocation reason.
In addition, CMS is proposing to expand the number of reasons for which the agency can take action against problematic providers. These would include, but not be limited to, the following:
- CMS could revoke a provider’s or supplier’s Medicare enrollment if the enrollment presents a high risk of fraud, waste, and abuse because the provider/supplier is located within a limited geographic area that has an excessive number of providers and suppliers.
- CMS could deny or revoke a provider’s or supplier’s Medicare enrollment if they have been convicted of a misdemeanor related to sexual assault or financial misconduct within the past ten years.
- CMS is proposing to make all revocation grounds retroactive to the date the provider’s noncompliance began. Under current regulations, certain Medicare enrollment revocations become effective 30 days after the date that CMS or the CMS contractor mails notice of the revocation.
- CMS is adding or expanding the grounds for revocation or denial, including a change in majority ownership and program or license suspension or termination.
To view a fact sheet on the proposed rule, visit the CMS website.
To read the proposed rule, visit The Federal Register.
