CMS Proposes to Increase Reward for Medicare Fraud Whistleblowers

Date posted: May 7, 2013

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule that would reward whistleblowers up to $9.9 million for reporting Medicare fraud. The proposed rule would increase the rewards of the Medicare Incentive Reward Program from 10 percent to 15 percent of the total amount recovered. Additionally, the proposed regulations would strengthen certain provider enrollment requirements, including:

  • Denying enrollment of a provider, supplier, or owner affiliated with a company that has unpaid Medicare debt.
  • Denying or revoking billing privileges of a provider or supplier if the provider, supplier, or any owner or managing employee of the provider or supplier has felony convictions within the past 10 years.
  • Limiting the ability of ambulance companies to “back bill” for services delivered prior to enrollment.

CMS anticipates that the proposed changes will strengthen the agency’s ability to promptly detect fraud, waste, and abuse and, as a result, protect the Medicare program.

CMS is accepting comments on the proposed rule until June 28, 2013.

The proposed rule is available here.

The CMS press release on the proposed rule is available here.

The CMS fact sheet on the Proposed Rule is available here.

Medicare Program; Requirements for the Medicare Incentive Reward Program and Provider Enrollment; Proposed Rule, 78 Fed. Reg. 82 25013, 25014 (Apr. 29, 2013).

Centers for Medicare & Medicaid Services. “HHS Would Increase Rewards for Reporting Fraud to Nearly $10 Million.” Press Release. 24 Apr. 2013.

Centers for Medicare & Medicaid Services. “CMS Proposes New Safeguards and Incentives to Reduce Medicare Fraud.” Fact Sheet. 24 Apr. 2013.

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