Stricter supervision of Medicare billing agencies
The new health reform law signed by President Obama on March 23, 2010 includes a requirement that billing agents, clearinghouses, and any other alternate payee that submits Medicaid claims on behalf of a healthcare provider, must register with the State and Secretary of HHS “in a form and manner specified by the Secretary.”
UPDATE 3/23/10 – The proposal discussed in the balance of this article was not included in legislation enacted by Congress and signed by the President.
The health reform proposal just posted on the White House website would go farther by adopting a provision from a bill sponsored by Representative Mark Kirk (R-IL) and 12 Republican co-sponsors that would impose significant new requirements on any “individual or entity” that compiles or submits Medicare claims seeking reimbursement on behalf of someone else.
Under a provision in H.R. 3970 (the “Medical Rights and Reform Act of 2009”), billing agencies and agents who submit claims to Medicare, who will be required to register with HHS and may be denied registration for various reasons. They would also become subject to exclusion from Medicare for submitting a Medicare claim that the biller knew or should have known was false or fraudulent.
Criminal background checks would be conducted before an agent or agency is permitted to register, and registration would be denied to applicants found to have history of acts that indicate that their registration “would be detrimental to the best interests” of the Medicare program or its beneficiaries. Such “acts” may include bankruptcy, any act resulting in a civil judgment against the applicant, or any felony conviction under federal or state law.
Once registered, the billing agency or agent remains subject to periodic targeted reviews.
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Tags: anti-fraud, H.R. 3970, health reform, healthcare reform