CMS to Vastly Increase Rewards for Fraud, Abuse Whistleblowers

A new proposed rule from the Centers for Medicare and Medicaid Services would put a lot more money behind rewards for information on individuals or entities engaging in Medicare fraud and abuse.

Under current rules, a reward is limited to 10 percent of overpayments recovered in a case or $1,000, whichever is less. Now, CMS proposes raising the reward to 15 percent of the final amount collected, up to a reward cap of $9.9 million.

The rule, being published April 29 and now available here, also would enable CMS to deny Medicare enrollment of providers affiliated with an entity that has unpaid Medicare debt, deny or revoke billing privileges for individuals with felony convictions, and revoke providers and suppliers abusing billing privileges.

CMS has recovered nearly $15 billion in fraudulent payments during the past three years, some of it reported by individuals. Now, the agency wants to increase individual participation in fraud prevention. Separate from the rule, a new $7.3 million funding announcement will expand the Senior Medicare Patrol program that educates beneficiaries on how to detect and report fraud, waste and abuse.