Reading the Tea Leaves on Medicare Provider Enrollment Ownership and Affiliation Disclosures

• March 01, 2024

• Stephen Angelette , Polsinelli PC
• Tammy Woffenden , Locke Lord LLP

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have long expressed concerns with the challenges of prospectively identifying bad actors who participate in Medicare, particularly through direct or indirect ownership in providers and suppliers enrolled in the program. In November 2008, OIG issued an Early Alert Memorandum expressing the belief that numerous suppliers of durable medical equipment, prosthetics, orthotics, and supplies and home health agencies with outstanding Medicare debts may inappropriately receive Medicare payments by, among other means, operating businesses that are “publicly fronted by business associates, family members, or other individuals posing as owners.”¹ On March 2, 2011, OIG testified in front of a House Energy and Commerce subcommittee that bad actors in the industry recruit and pay “nominee owners” to operate businesses while concealing the true ownership of the entity.² In this way, providers and suppliers would hide their true ownership, bill the Medicare program millions of dollars, then close down, take over another company, and repeat the process.³

ARTICLE TAGS

• Regulation, Accreditation, and Payment Practice Group
• Government Reimbursement