tci Medicare Compliance & Reimbursement - 2013 Issue 15

See What the ACA Says About Compliance Programs

Review the following directive from the Affordable Care Act creating the requirement for formal compliance programs as a condition of participation with governmental insurers: Subtitle E — Medicare, Medicaid, and CHIP Program Integrity Provisions SEC. 6401. PROVIDER SCREENING AND OTHER ENROLLMENT REQUIREMENTS UNDER MEDICARE, MEDICAID, AND CHIP. ‘‘(7) COMPLIANCE PROGRAMS.— ‘‘(A) IN GENERAL. — On or after the date of implementation determined by the Secretary under subparagraph (C), a provider of medical or other items or services or supplier within a particular industry sector or category shall, as a condition of enrollment in the...

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