CMS Issues Final Rule on Certain Fraud and Abuse Provisions of the Affordable Care Act - February 9, 2011

On Feb. 2, the federal Centers for Medicare & Medicaid Services issued a final rule with comment period implementing specific fraud and abuse provisions of the Affordable Care Act. Among other items, the rule addresses the following:

• Guidance on the termination of providers from Medicare if terminated by a Medicaid state agency
• Risk categorization for providers
• Requirements for suspension of payments pending investigation of credible allegations of fraud in the Medicare or Medicaid programs
• Proposed fingerprinting of “high-risk” providers.