Waltz Comments on New CMS Program-Integrity Regulation

Partner Judith Waltz was quoted in a Report on Medicare Compliance article, “CMS Rule: Providers Could Lose Medicare Privileges Because of Tainted ‘Affiliations,’’ about a new CMS rule designed to keep, or kick, providers out of Medicare if they pose an undue risk of fraud, waste or abuse.

Waltz said the new rule, which takes effect Nov. 4, is a very big deal. “It’s like data mining on steroids, because as a provider, you have to figure out who your affiliates are, and all this information goes on your 855 enrollment form,” she said.

If a provider has what is known as a “disclosable event,” that is discovered by CMS, Waltz added, the provider could be subject to a civil monetary penalty. “It’s scary,” she said. “I get where they’re coming from on this, but there may be some harsh results in certain situations.”

Read the full article here.