Judith Waltz on CMS's Shift Toward 'Enforcement by Enrollment'
Foley & Lardner LLP partner Judith Waltz shares insights on Centers for Medicare & Medicaid Services’ (CMS) approach to fraud prevention in the Report on Medicare Compliance article, “CMS Pursues ‘Enforcement by Enrollment,’ Inviting a Change in Mindset’ About Enrollment.”
Addressing CMS’ evolving approach, Waltz observed that the agency is engaging in “enforcement by enrollment,” explaining, “They’re focusing on tools to avoid the submission of claims that suggest fraud, waste, and abuse from ‘suspect’ providers that, because of CMS’s prior experience, they know are out there.”
On skilled nursing facilities (SNFS) and nursing home requirements, she said, “it’s very burdensome,” with CMS wanting more information from people and companies, specifically from private equity and real estate investment trusts. “The degree of disclosures that are required are so much higher for SNFs than any other type of provider,” Waltz added.
She also commented on the federal government’s expanded use of moratoria on Medicaid as a tool to combat fraud. Waltz noted that the administration has increased reliance on enrollment freezes, adding that CMS instructed state Departments of Human Services to freeze enrollment for 13 provider categories and to revalidate existing providers in those groups.
