--For the limited level, verification of any provider/supplier-specific requirements established by Medicare license verifications, licensure checks across states and database checks (for instance, to verify Social Security Numbers or National Provider Identifiers);

--For the moderate level of risk, the screening would include the tools for the limited level, as well as conducting unannounced pre- or post-enrollment site visits;


--For the high level of risk, the screening would include the tools for limited and moderate levels and a criminal background check and submission of fingerprints, to be applied to owners, authorized or delegated officials or managing employees of any provider or supplier within the high level of risk.

Other screening tools proposed are:

--An application fee for providers and suppliers to cover the cost of screening and to carry out the screening and other program integrity efforts;

--Possible temporary moratorium on the enrollment of new Medicare providers and suppliers in six-month increments in situations where CMS identifies a trend that appears to be associated with a high risk of fraud, waste or abuse or identifies either a particular provider, supplier type or geographic area as having a significant potential for fraud, waste or abuse;

--Guidance for states regarding termination of providers from Medicaid and CHIP if terminated by Medicare; and

--Requirements for suspension of payments pending credible allegations of fraud in the Medicare and Medicaid programs.

CMS is also requesting comments on provisions of the Affordable Care Act that require providers of medical or other items or services or suppliers within a particular industry sector or category to establish compliance programs.

CMS requests that comments be received by November 16, 2010. Comments can be submitted electronically through http://www.regulations.gov, referring to file code CMS-6028-P, or by regular mail to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6028-P, P.O. Box 8020, Baltimore, MD 21244-8020.

More on the proposed rules may be found here: http://www.ofr.gov/OFRUpload/OFRData/2010-23579_PI.pdf.

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