Judith Waltz Discusses CMS Administrative Actions Related to COVID-19 Health Fraud Schemes

Foley & Lardner LLP Partner Judith Waltz is quoted in the article, “CMS Administrative Actions Are Added to National COVID-19 Fraud Takedown; PIM Is updated,” in the Report on Medicare Compliance, published by the Health Care Compliance Association (HCCA).

Centers for Medicare & Medicaid Services (CMS) administrative actions, like payment suspensions and billing revocations, against providers are a lesser known piece of the sweeping national enforcement action for alleged health fraud schemes related to the COVID-19 pandemic, but they happen much faster than civil and criminal cases and put a hold on a provider’s Medicare reimbursement without appeal rights. A Medicare Program Integrity Manual (PIM) update on April 21, 2022, “further demonstrates CMS’s intention to act quickly in cases of suspected fraud,” said Waltz.

CMS’s administrative actions often get less attention than criminal charges or civil False Claims Act (FCA) lawsuits, but “these CMS authorities include powerful enforcement tools that can have a significant impact on providers,” Waltz said. Payment suspensions can continue for a prolonged period, noted Waltz, during which the provider must operate without Medicare payments – or shut down if it can’t survive without that cash flow. “It gives the government an immediate remedy to stop further payments from going out the door,” she said.

Waltz is the co-chair of the firm’s Health Care Practice Group and Health Care Industry Team.