CMS considers regulatory changes in wake of mounting healthcare fraud reports: 4 insights

CMS is considering regulatory changes after surfacing reports show providers may be steering patients toward private plans to receive higher reimbursement, according to Washington Examiner.

Here are four insights:

1. Some insurers are filing suits for providers allegedly engaging in "patient dumping," which entails helping patients pay their premiums for private payers. The practice allows providers to receive higher payments from private payers, as opposed to Medicare and Medicaid plans.

2. CMS' regulatory changes could include implementing caps on premium payments insurers give providers.

3. Other changes may include modifying Medicare or Medicaid provider enrollment rules or fining providers for not giving patients accurate information when enrolling patients in a plan.

4. CMS also said officials should fine providers when their advice causes Medicare-eligible patients to delay enrolling in Medicare because providers steered those patients toward a private insurer.

"We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients' needs," said CMS Acting Administrator Andy Slavitt. "These actions can limit benefits for those who need them, potentially result in greater costs to patients, and ultimately increase the cost of marketplace coverage for everyone."

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