CMS gets new powers to go after Medicare, Medicaid fraudsters

by Robert King | Sep 5, 2019

The Trump administration issued a new rule that aims to prevent payments to Medicare and Medicaid fraudsters by boosting revocation powers and extending the time before troublesome organizations can rejoin the programs.

The Centers for Medicare & Medicaid Services said that the final rule issued Thursday marks a major turnaround from the agency’s normal approach of attempting to recoup fraudulent payments after the fact.

“For too many years, we have played an expensive and inefficient game of ‘whack-a-mole’ with criminals⁠—going after them one at a time⁠—as they steal from our programs,” CMS Administrator Seema Verma said in a statement Thursday. “Now for the first time, we have tools to stop criminals before they can steal from taxpayers.”

The rule gives CMS new powers to revoke or deny organizations from participating in Medicare, Medicaid or the Children’s Health Insurance Program.

A new “affiliations” authority lets CMS identify individuals or organizations that have a high risk of fraud, waste or abuse based on their association with previously sanctioned people or groups, a release on the new rule said.


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Chris J. Stewart

Chris currently serves as Chief Executive Officer of Surgio Health as well as Chief Operating Officer at Ortho Spine Partners. Prior to that, he was the assistant vice president and business unit leader of Medical Device Management for HealthTrust Purchasing Group (HPG).

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