Proposed CMS Program Aims to Prevent Medicare/Medicaid Fraud

CMS is proposing a program that would require medical providers and suppliers to undergo stricter screening if they want to participate or enroll in Medicare and Medicaid.

Under the plan, suppliers and providers would be assessed for their risk of fraud, waste and abuse. They would then be placed into one of three risk groups: limited risk, moderate risk and high risk. Each group would have to meet different criteria for enrollment and participation, with high-risk applicants being subject to more rigorous evaluation that would include criminal background checks and fingerprinting in addition to other Medicare and Medicaid requirements.

The goal of the program is to help prevent fraud before it happens and to shift CMS to a fraud prevention model rather than a "pay-and-chase" enforcement model.

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