CMS Revokes 14,000 Medicare Licenses Under ACA, To Date

In just two years after the implementation of the Affordable Care Act (ACA), the number of Medicare license revocations more than doubled compared to preceding years, according to data released by the Centers for Medicare & Medicaid Services (CMS).

Since March 2011, CMS has revoked 14,663 providers’ and suppliers’ ability to bill in the Medicare program. In the two years before the ACA strengthened provider screening as a way to limit fraud, 6,307 providers had their Medicare licenses revoked.

In 18 states, the number of revocations had quadrupled since CMS put the ACA screening and review requirements in place, as well as the implementation of proactive data analysis to identify potential license discrepancies of enrolled individuals and entities.

For example, two years before ACA boosted its screening efforts, Texas had 703 revocations. In the two years after ACA screening, the Lone Star state had 1,417.

Additionally, before ACA screening, the number of states with more than 600 revocations was limited to Texas, Florida and California. Today New York, Ohio and Pennsylvania have joined those original three states.

Grounds for removal from the Medicare program, according to CMS, were because providers either had felony convictions, were not operational at the address CMS had on file, or were not in compliance with CMS rules.

Since then the Obama Administration has undertaken numerous efforts to prevent fraudulent billing to the Medicare program, recovering over $14.9 billion in healthcare fraud judgements, settlements and administrative impositions.

In April, CMS announced a proposed rule that would increase whistleblower rewards—up to $9.9 million—paid to Medicare beneficiaries and others whose tips about suspected fraud could lead to a recovery of funds.

The Administration is now calling upon the nation’s seniors to aid in the fight against healthcare fraud.

In mailboxes across the county, people with Medicare will soon see a redesigned statement of their service claims and benefits to help them better identify fraud.

“The New Medicare Summary Notice gives seniors and people with disabilities accurate information on the services they receive in a simpler, clearer way,” said CMS Administrator Marilyn Tavenner. “It’s an important tool for staying informed on benefits, and for spotting potential Medicare fraud by making the claims history easier to review.”

CMS will send the notices to Medicare beneficiaries on a quarterly basis.

“A beneficiary’s best defense against fraud is to check their Medicare Summary Notices for accuracy and to diligently protect their health information for privacy,” said Peter Budetti, CMS deputy administrator for program integrity.

“Most Medicare providers are honest and work hard to provide services to beneficiaries,” added Budetti. “Unfortunately, there are some people trying to exploit the Medicare system.”

Written by Jason Oliva