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CMS extends, expands fraud-fighting provider enrollment moratoria efforts in six states

Expansion goes along with new initiative to allow exceptions to the moratorium, heightened screening requirements for new providers.

Beth Jones Sanborn, Managing Editor

CMS Headquarters-Windsor Mill, MDCMS Headquarters-Windsor Mill, MD

The Centers for Medicare and Medicaid Services will extend and expand a temporary moratorium on provider enrollment in six states meant to combat fraud, and at the same time, has created a new related demonstration project to allow for certain exceptions to the moratoria and heightened screening requirements for new providers, the agency announced Monday.

CMS is extending the moratorium for six months and expanding it statewide on new Medicare Part B non‑emergency ground ambulance suppliers in New Jersey, Pennsylvania, and Texas, and home health agencies in Florida, Texas, Illinois, and Michigan.  The statewide expansion also applies to Medicaid and CHIP

In tandem with the moratoria expansion, CMS also announced an initiative called the Provider Enrollment Moratoria Access Waiver Demonstration. This allows for provider and supplier enrollment exceptions in the moratoria areas.

[Also: Insight on the revised Medicare provider enrollment regulations]

"The statewide expansion of the temporary moratoria coupled with the PEWD will allow CMS to continue to target fraud within these services while granting individual enrollment waivers.  These changes will address access to care issues and allow providers and suppliers who are subject to the moratoria to enroll in Medicare, Medicaid, and CHIP after passing heightened screening requirements," CMS said in a statement.

The agency has also immediately lift the current temporary moratoria on all Medicare Part B, Medicaid and CHIP emergency ground ambulance suppliers.

The moratoria and related investigations are part of the agency's "comprehensive strategy". CMS said program integrity activities saved Medicare $21.1 billion in 2013 and $18.1 billion in 2014.