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CMSRulemakingCMS-2010-0239

Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria Payment Suspensions and Compliance Plans for Providers and Suppliers

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National Community Pharmacists Association filings
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National Community Pharmacists Association filed 1 comment on this docket between Dec 8, 2010 and Dec 8, 2010. 65 other organizations filed here. The comment window closed 5594d ago.

What National Community Pharmacists Association filed (1)

Dec 8, 2010· National Community Pharmacists Association -- VA· CMS-2010-0239-0121

VIA Electronic Submission to http://www.regulations.gov November 16, 2010 Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-6028-P P.O. Box 8020 Baltimore, MD 21244-8020 Subject: CMS-6028-P; Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers Dear Sir or Madam: Thank you for the opportunity to submit our comments on CMS's proposed rule to implement provisions of the Affordable Care Act concerning new requirements for fraud, waste and abuse prevention in Medicare, Medicaid and CHIP. As CMS considers issues pertinent to implementing the new fraud, waste and abuse prevention requirements, the National Community Pharmacists Association (NCPA) appreciates the opportunity to share our perspectives. NCPA represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies, pharmacy franchises, and chains. Together they represent a $93 billion health-care marketplace, have more than 315,000 employees including 62,400 pharmacists, and dispense over 41% of all retail prescriptions. NCPA members are the primary providers of drugs and pharmaceutical supplies to millions of Americans. NCPA members work hard to avoid creating waste within the Medicare, Medicaid and CHIP programs. Moreover, NCPA members are not a source of the major fraud and abuse problems within the latter three programs. NCPA and its members enthusiastically support CMS's efforts to strengthen the integrity of the three programs and to fight against fraud, waste and abuse within those programs. Accordingly, NCPA generally supports the goal of CMS's proposal. However, given that community pharmacies are a not major source of fraud, waste and abuse within the three programs, NCPA urges CMS to revise some of the requirements that it intends to impose upon community pharmacies under the proposed rule in order to ease the unnecessary and heavy administrative and financial burdens on community pharmacies that will likely follow from the proposed rule, if implemented.   Suspension of Payments NCPA supports the general concept that CMS suspend payments to DME suppliers who are likely to have committed fraud. However, NCPA is concerned that the process and procedures that CMS intends to use to determine the suspension of payments for a given supplier are too broad and could lead to CMS suspending payments for those who have not committed any fraud. Under the Proposed Rule, credible allegations of fraud can arise from any source, including hotline complaints. The fact that allegations can come from any source and even an anonymous tip from a hotline raises major concerns that tipsters operating for their own benefit will abuse the fraud reporting system. For example, a tipster who is a competitor of a community pharmacy could phone in an anonymous false fraud tip against a community pharmacy and trigger an investigation and possible suspension of payments to that community pharmacy, even though that community pharmacy has not engaged in fraud. This same scenario could arise with regard to disgruntled former pharmacy employees. In other words, tipsters may falsely report fraud in order to trigger payment suspensions in an effort to eliminate competition or to seek revenge against a former employer. To make matters worse, CMS proposes to treat an allegation of fraud as credible, provided it has an "indicia of reliability," a term which is undefined in the Proposed Rule. The definition of what is credible or reliable under the Proposed Rule is completely circular; an allegation is reliable if it has an "indicia of reliability." The ability to determine what allegations are or are not reliable for purposes of triggering payment suspensions is made even more difficult by the Preamble's indicati…

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Abstract

This proposed rule would implement provisions of the Affordable Care Act that establish: Procedures under which screening is conducted for providers of medical or other services and suppliers in the Medicare program, providers in the Medicaid program, and providers in the Children’s Health Insurance Program (CHIP); an application fee to be imposed on providers and suppliers; temporary moratoria that may be imposed if necessary to prevent or combat fraud, waste, and abuse under the Medicare and Medicaid programs, and CHIP; guidance for States regarding termination of providers from Medicaid and CHIP if terminated by Medicare or another Medicaid State plan or CHIP; guidance regarding the termination of providers and suppliers from Medicare if terminated by a Medicaid State agency; and requirements for suspension of payments pending credible allegations of fraud in the Medicare and Medicaid programs. This proposed rule would also present an approach and request comments on the 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.

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