New CMS Rule Cracks Down on Past Medicare Offenders

December 7, 2014

A new rule by CMS to punish "bad actors" and new concern with the Independent Payment Advisory Board highlight the problem with Medicare and Medicaid.

On Dec. 3, CMS issued a final rule giving the agency greater power to deny or revoke enrollment to providers, by scrutinizing employees and owners of providers, who may have a less than stellar history with the Medicare program.  The government is also considering greater reliance on the IRS to assist with delinquent recoupment collections.  

Among the highlights:

· Adding the ability to deny the enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt. CMS says this will help prevent individuals and entities from being able to incur substantial debt to Medicare, leave the Medicare program, and then re-enroll as a new business to avoid repayment of the outstanding Medicare debt. CMS will only enroll otherwise eligible individuals or entities if they repay the debt or enter into a repayment plan.

· Adding the ability to deny the enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses. This provision ensures that CMS can block or remove bad actors from the Medicare program to protect beneficiaries and safeguard the Medicare trust funds.

· Permitting CMS to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements. This is intended to address providers and suppliers that regularly submit improper claims in such a way that it poses a risk to the Medicare program.

Meanwhile, The Hill reported recently  that, "Twenty-five Republicans are asking the Supreme Court to take up another case against Obamacare, this time challenging a controversial medical board that the party has labeled 'a death panel.'"  The dust-up, this time, involves something called the Independent Payment Advisory Board (IPAB), which is charged with cutting Medicare spending if it exceeds a certain level.

Why are these two stories related? The new CMS rules and the IPAB issue perfectly describe the   Medicare and Medicaid problem.  Spend too much, then make the only rules anyone can actually agree on: Those which punish physicians and providers. 

The idea behind IPAB is that we can't afford to keep spending as if there were no tomorrow, but we can't trust elected officials to ever say, "No, we can't afford it." IPAB was designed to make these hard "end-of-life vs. how much it costs" choices;  makes perfect sense, even if the solution isn't perfect. 

Common fiscal sense, however, goes out the window, when politics are factored into the equation. The result is a government which spends way too much and won' t make hard choices about cutting spending. 

Instead, we continue to create a system in which it is possible for physicians and providers to rack up huge amounts in "Medicare debt," and then must enter an agreement to work it off, or they cannot find work at all. 

Maybe this new rule will only be targeted at the really bad apples; I am not so sure.  I am starting to hear echoes of Tennessee Ernie Ford's Dust Bowl song, "Sixteen Tons," about company stores, and company debt, which can never be worked off.