Supplier Anti-Fraud Demo Begins in Florida, California

BALTIMORE–CMS said it had instructed the National Supplier
Clearinghouse to begin its anti-fraud demonstration project on Nov.
1.

Announced in July, the demonstration will involve all South
Florida DMEPOS suppliers in Miami-Dade, Broward and Palm Beach
counties, and Southern California suppliers in Los Angeles, Orange,
Riverside and San Bernardino counties. (See HomeCare
Monday, July 9.)

The project’s three major components were described in a notice
about the demonstration as follows:

1. Immediate submission of CMS 855S
application–Each DMEPOS supplier in the demonstration
locales will be required to submit a CMS 855S Medicare enrollment
application to the NSC within 30 days after the NSC requests such
data.

The NSC will notify suppliers by letter to submit the CMS 855S.
The letter will contain instructions and indicate a date by which
the form must be received by the NSC. If the form is not received
timely, the supplier’s billing privileges will be revoked. No
extensions will be granted. The NSC will begin mailing these
letters on Oct. 31, 2007.

Note: In order to properly administer this project, please do
not submit a CMS 855S reenrollment application until notified to do
so by the NSC.

2. Revocation of billing privileges–Under this
demonstration, a DMEPOS supplier’s Medicare billing privileges will
be revoked in the following circumstances:

–The DMEPOS supplier failed to submit a CMS 855S application
within the aforementioned 30-day timeframe.
–The DMEPOS supplier failed to report a change in ownership or
address at least 30 days prior to the effective date of the
change.
–The DMEPOS supplier failed to obtain accreditation from an
approved DMEPOS accrediting organization within 120 days of
notification from the NSC to do so.

Note: Not every DMEPOS supplier will be required to obtain
accreditation under this demonstration. Only those that are
notified by the NSC to become accredited will be subject to that
requirement.

–The DMEPOS supplier has an owner or managing employee that has
had a felony conviction within the last 10 years.
–The DMEPOS supplier no longer meets each and every requirement
necessary for enrollment as a DMEPOS supplier.
–If the supplier’s billing privileges are revoked, CMS will
implement recoupment measures as appropriate.

3. Enhanced review of “remaining” DMEPOS
suppliers–DMEPOS suppliers that do not have their
Medicare billing privileges revoked based on the information
contained in the CMS 855S application they submitted will be
subject to an enhanced review

This may include but is not limited to additional unannounced
site visits and targeted claims reviews.

For more information about the demonstration project, visit

www.cms.hhs.gov/MedicareProviderSupEnroll and click on the
“Enrollment Demonstrations” link on the left-hand side of the
page.