RFK, Jr. Puts More Muscle into CMS Fraud/Abuse Crackdown

Exclusion authority is being expanded to more levels of the Dept. of Health and Human Services (HHS), including to more easily allow the Centers for Medicare and Medicaid Services (CMS) to oust SNFs and other providers from the Medicare and Medicaid programs if they are deemed “bad actors” in committing fraud and abuse.

That’s the new word from Robert Kennedy Jr., head of HHS, and CMS Administrator Mehmet Oz in a Tuesday press conference to announce a massive crackdown on California and Minnesota Medicaid programs.

First, on the expanded use of exclusionary authority. Kennedy, Jr. said, “[CMS] would now be able to use that authority [previously not given to CMS] to remove bad actors from federal healthcare programs and in many cases, to permanently ban them from returning.”

On the newest actions against the states, HHS and CMS said they have deferred more than $1 billion in federal Medicaid payments to California and Minnesota as the state submits additional documentation supporting certain high-risk Medicaid claims.

“Medicaid exists to serve vulnerable Americans, not to bankroll unsupported claims,” Kennedy, Jr. said.

CMS said it is reviewing claims from specific home care programs in California, and in Minnesota 14 high-risk service areas with questionable claims.

CMS officials said for the first quarter of this year, it has revoked 1,413 providers and suppliers, an increase of around 40 percent from recent years.

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