Re: Program Integrity Enhancements to the Provider Enrollment Process; Proposed Rule; 81 Fed. Reg.
405, 424, 455 (March 1, 2016)
Dear Acting Administrator Slavitt:
The undersigned physician organizations representing national medical societies are writing to provide
comments on the proposed rule (CMS-6058-P) implementing program integrity enhancements to the
provider enrollment process for Medicare, Medicaid, and the Children’s Health Insurance Program
(CHIP).
Our organizations strongly support the efforts of the Centers for Medicare & Medicaid Services (CMS) to
protect its trust funds by ensuring that unqualified or potentially fraudulent individuals or entities are
precluded from billing applicable programs. However, we are concerned that certain provisions in the
proposed rule would significantly increase regulatory burden without efficiently targeting enforcement
toward higher-risk enrollees. Accordingly, we offer suggested modifications to the proposed rule below.
First, CMS proposes a 5-year “look-back” period for previous affiliations. However, the event triggering
the disclosure is not subject to any look-back limitations, meaning that the disclosable event could have
occurred long in the past and before the reporting physician even established an affiliation with that
entity. As the examples included in the rule suggest, the combination of a 5-year affiliation look-back
period with an unlimited look-back period for the disclosable event creates an infinite look-back
obligation for reporting physicians. For this reason, we highly recommend establishing a finite look-back period for disclosable events, which should in no case precede the date that the physician established
a covered affiliation with the relevant entity.
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Read full letter here
