Title VI. Transparency and Program Integrity

Reining in Fraud, Waste and Abuse in Medicare, Medicaid, and CHIP

The Act cracks down on high-risk providers and suppliers who defraud the American taxpayer in the Medicare, Medicaid, and CHIP programs.

Providers and suppliers enrolling or re-enrolling in these programs will be subject to a new compliance program.  They will be subject to tougher standards and criminal background checks. They’ll be required to disclose all affiliations with any provider or supplier that has uncollected debt, has had their payments suspended, has been excluded from participating in a Federal health care program, or has had their billing privileges revoked.

The Inspector General of HHS will oversee a new comprehensive data base including any provider or practitioner who has been sanctioned under Medicare or Medicaid to help law enforcement keep fraudulent providers out of these programs.

The Act provides new authority to deny enrollment in any of these programs if these high-risk affiliations pose an undue risk to the program and the American taxpayer.

New sanctions will be imposed on individuals who purchase, sell, or distribute Medicare beneficiary identification numbers or provider billing numbers, including jail time.

Continue to Enhanced Medicare and Medicaid Program Integrity Provisions