Improving Transparency and Due Process in Medicare Payment Suspensions for Fraud Investigations.
This Act aims to protect patient access to healthcare by increasing fairness and transparency when Medicare payments to providers are suspended due to suspected fraud. It introduces new rules to prevent legitimate healthcare facilities from closing down because of unjustified payment freezes. Citizens benefit from greater stability in the healthcare system, ensuring their providers can operate reliably.
Key points
Limits the duration of payment suspensions for Medicare providers to 180 days, unless there is good cause for extension.
Requires the CMS agency to inform providers about the specific details of fraud allegations 30 days before suspending payments (unless it compromises the investigation).
Establishes an independent appeals process allowing providers to quickly challenge payment suspension decisions.
Clarifies that simple billing errors or human errors are not automatically considered credible allegations of fraud.
Introduced
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