Staying Ahead of the Fraud and Abuse Enforcement Curve Regarding the Affordable Care Act, in Corporate Compliance Insights

Following is an excerpt from the article:

On March 25, regulations went into effect implementing significant new fraud and abuse enforcement provisions contained in the federal Affordable Care Act (ACA). These include expanding the authority for the Centers for Medicare and Medicaid Services (CMS) and individual states to temporarily suspend payments to a provider or supplier pending an investigation of a credible allegation of fraud.

The new rules also require states to terminate a provider from the Medicaid and Children's Health Insurance Program (CHIP) programs where that provider has been terminated from the Medicare program or another state's Medicaid or CHIP program, and authorizes CMS to impose a temporary moratorium on the enrollment of new providers and suppliers if necessary to prevent or combat fraud, waste or abuse.