• Final Rule Implementing Anti-Fraud Provisions of the Affordable Care Act
  • February 9, 2011
  • Law Firm: Alston Bird LLP - Atlanta Office
  • On January 24, 2011, CMS finalized a rule to implement significant anti-fraud provisions of the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), as amended by the Health Care and Education Reconciliation Act (Pub. L. No. 111-152) (collectively, the “Affordable Care Act” or “ACA”) that would impact both current and prospective providers and suppliers enrolled in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP). The final rule emphasizes fraud prevention. These new policies attempt to steer CMS away from engaging in “pay and chase.” In such a situation, the agency detects fraud after the fact and then attempts to both recoup payments made and take actions against the perpetrators of the fraud. The rule is designed to ensure “that only legitimate providers and suppliers are enrolled in Medicare, Medicaid, and CHIP, and that only legitimate claims will be paid.”