Medicare program; withholding of payments to practitioners, providers, and suppliers of services--Health Care Financing Administration. Proposed rule.
This proposal would amend existing regulations to provide timely notice and administrative review when Medicare payments for services are withheld because there is evidence of fraud. This proposal would specify what constitutes evidence of fraud sufficient to support withholding: where a case is under criminal investigation, or a formal criminal charge has been issued, or a civil suit has been filed, or the procedures for exclusion from the Medicare program have been initiated because of fraud related to the Medicare program. The purpose of this proposal is to specify in regulations procedures to protect the interests of providers, practitioners, and suppliers of service without compromising pending actions or procedures or the ability of the Federal government to protect funds.
D003415:Crime; D005607:Fraud; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence*; D014481:United States