Medicare and Medicaid programs; suspension of health care professionals for conviction of program-related crimes--HCFA. Final regulations with comment period.
These regulations expand existing policy relating to suspension of individuals from participation in Medicare and Medicaid if they are convicted of program-related crimes. The suspension provisions will now apply to operators and administrators of health care facilities, pharmacists, and other individuals receiving reimbursement for services, as well as to physicians and other individual practitioners who were previously covered. The regulations provide for suspensions from participation in Medicare and Medicaid if the individual is convicted of a program-related crime relating to the delivery of medical care or services under the Medicare, Medicaid, or title XX Social Services programs. These regulations also require State Medicaid agencies to have the ability to exclude from Medicaid program reimbursement providers who otherwise defraud or abuse the Medicaid program, and revise State Medicaid requirements for the detection and investigation of Medicaid fraud and abuse. All of the provisions are intended to prevent or discourage abusive or fraudulent practices that increases the cost of the Medicare and Medicaid programs without benefiting beneficiaries or recipients. The suspension provisions implement Section 913 of the Omnibus Reconciliation Act of 1980. The exclusion provisions are intended to make the Medicaid policy consistent with Medicare policy.
D014487:Centers for Medicare and Medicaid Services, U.S.; D003415:Crime; D005607:Fraud; D006278:Medicare / Q000331:legislation & jurisprudence*; D014481:United States