1.4M Healthcare Providers Will Soon Be Required to Revalidate Medicare Enrollment as Part of Anti-Fraud Effort

Approximately 1.4 million healthcare providers, including roughly 750,000 physicians, will be required to revalidate their Medicare enrollment records as part of an anti-fraud initiative called for in the Patient Protection and Affordable Care Act, according to an amednews report.


Providers who enrolled as a Medicare provider before March 25, 2011, will receive the requests by mail between now and March 23, 2013, and will have 60 days after receiving the request to recertify their enrollment. Providers that do not reenroll could face losing Medicare billing privileges.

While providers have reported the Medicare enrollment process can be tedious and delayed, CMS is planning improvements, including online enrollment options, beginning in Jan. 2012, according to the report.

Physicians and non-physician practitioners, all of which fall into CMS' "limited risk" category will be subject to license verification, verification of social security and tax ID numbers and other verification requirements set by Medicare as part of the reenrollment process. Higher-risk groups, including physical therapy, x-ray, home health and equipment providers may be subject to unscheduled site visits and fingerprint-based background checks, according to the report.

Related Articles on Healthcare Fraud Prevention:

Careful Investigation of Internal Complaints May Reduce Fraud Exposure
HHS Inspector General Recommends CMS Respond to Fraud Hotline Complaints More Promptly
CMS Publishes Final Rule on Fraud Prevention and Regulations

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