Judith Waltz Discusses CMS Revocation Lists as Emerging Provider Screening Tool

Foley & Lardner LLP Judith Waltz shared insights in the Report on Medicare Compliance article, “Sutter Health Agrees to Pay $3.2M Over Alleged CSA Violations; Drug Waste Is a Vulnerability,” on revocation lists as a new screening tool.

On Centers for Medicare & Medicaid Services’ (CMS) searchable database of revoked providers and suppliers, Waltz said, “Having this transparency is really helpful. This ultimately should be a credentialing tool in the same way the exclusion list is.” She added that revocation of Medicare enrollment can trigger preclusion from Medicare Advantage plans and create problems with commercial insurers that rely on Medicare enrollment for credentialing.

Revocation also can jeopardize hospital privileges because hospitals expect clinicians to remain in good standing with Medicare, and “some hospital bylaws expressly require that,” Waltz said. “After the date of the revocation, which may be retroactive, CMS won’t pay the revoked practitioner,” and CMS or its contractors may also deny payment to the related hospital.

On corrective action plans, Waltz warned that “CAPS are now very limited because of a 20214 regulatory change.” “CAPs are only available for noncompliance (as set forth in (a)(1). It won’t be available for the other grounds for revocation,” such as providing false or misleading information, misuse of a billing number or failure to report. “The deficiencies contemplated by (a)(1) would be things that can be readily fixed,” such as an expired license or other conduct “that doesn’t pose a risk to the program or its beneficiaries,” she explained.