Medicare Extends Provider Enrollment Ban Again


Current bans on ambulance and home health care providers in six states were extended another six months due to concerns about Medicare fraud.

In a notice (CMS-6059-N7) published in the Federal Register July 28, the Centers for Medicare & Medicaid Services said the extensions were necessary due to a high risk of fraud and abuse associated with ambulance providers and home health agencies. The extension affects all new nonemergency ambulance providers in New Jersey, Pennsylvania, and Texas, and new home health agencies in Florida, Illinois, Michigan, and Texas. The CMS previously extended the bans in January. The extensions went into effect July 29.

Home health and ambulatory service groups said the extension was not surprising. “We were expecting it by the end of the month, because that’s when the previous extension ran out,” William Dombi, vice president for law at the National Association for Home Care and Hospice in Washington, told me July 27. “They’ve been extending it for years.” Dombi is a member of Bloomberg BNA’s advisory board.

“There’s no surprise here,” Tristan North, senior vice president of government affairs at the American Ambulance Association in McLean, Va., told me July 27.

The Affordable Care Act gave the CMS authority to implement temporary enrollment bans on Medicare, Medicaid, or Children’s Health Insurance Program providers and suppliers to combat fraud and abuse. The temporary bans were originally imposed in July 2013 and covered enrollment in several counties in Florida, Illinois, and Texas, and were expanded to counties in Michigan, Pennsylvania, and New Jersey the following year.

Read my full article here.

Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.

Learn more about Bloomberg Law and sign up for a free trial.