Judith Waltz Weighs CMS Anti‑Fraud Tools, Provider Screening, and Moratorium Risks

Foley & Lardner LLP partner Judith Waltz was quoted in the Report on Medicare Compliance article, “In Fraud ‘Crackdown,’ CMS Bans DME Suppliers, Promises Revocation List” discussing the evolving anti-fraud ecosystem, the Centers for Medicare & Medicaid Services’ (CMS) forthcoming provider screening tool, and benefits of moratorium.

“Everyone hates real fraud, but people can differ as to the definition of what is considered fraud,” Waltz said. “An aggressive definition of fraud and aggressive enforcement have to be balanced against the possibility that the approach may limit access to reasonable and necessary care.”

On CMS’s forthcoming provider screening tool, she noted that while revoked billing privileges are currently reported to certain organizations and databases, no public list is available. Waltz called public access to revocation and preclusion lists a “huge step forward.”

Addressing CMS’s DME supplier moratorium, Waltz shared she has “real doubts moratoria work.”

“You aren’t necessarily keeping less desirable operators out,” she explained. “It may be incentivizing those who have a pot of money and can pay a lot because they want to transfer a license as opposed to starting up their own business. And the approach may wind up with
an unintended consequence of limiting patient access to necessary services.”