RFK Jr. gives CMS authority to ban individual providers

The CMS is now authorized to ban individual healthcare providers from participating in Medicare and Medicaid, along with the HHS Office of the Inspector General, according to a new notice in the Federal Register.

The HHS Secretary, Robert F. Kennedy, Jr., issued a statement of delegation of authority yesterday morning, shifting authority to the CMS Administrator, Dr. Mehmet Oz.

"As the agency directly responsible for administering Medicare and Medicaid, CMS is uniquely positioned to investigate, identify, and develop the evidentiary basis underpinning permissive exclusion determinations," Kennedy stated. "Formalizing this delegation aligns investigative and enforcement responsibilities within a single operating division, reducing redundancy and improving program integrity outcomes."

Oz will now work alongside the HHS OIG to determine whether providers accused of fraudulent or abusive conduct can participate in federal programs. Although he will not be able to conduct hearings or issue regulations, the statement clarified.

The HHS OIG has held this authority since 1988, when the HHS Secretary at the time centralized the power to ban providers from Medicare and Medicaid under the Social Security Act. This allowed the government to enact administrative sanctions and civil remedies as it expanded the types of bans to include permissive exclusions, such as when a provider submits false claims or has their license suspended.

Since then, the HHS OIG has been the only entity that could issue a cross-cutting ban barring a provider from receiving federal healthcare funds. The agency has banned nearly 85,000 entities, according to its latest list of excluded individuals and entities.

However, Kennedy said in the statement that the CMS had requested the authority to be delegated to the head of the federal healthcare programs. The agency also proposed over the summer expanding the reasons it can boot certain providers from the programs, including when the provider's owners or management organizations are already in trouble with the agency.

Rooting out fraud, waste and abuse in Medicare and Medicaid has been a top priority for this administration. Kennedy, Oz and other federal officials also announced yesterday that they had kicked off 189,000 deceased and duplicate enrollees off the Affordable Care Act's marketplace plans, eliminating $738 million in improper payments this year.

They expect that number to swell to $1.5 billion by year's end as the HHS continues to identify these improper enrollments.

"Some cases begin with an error, others may reveal deliberate abuse," Kennedy said during the press conference.

Jacqueline LaPointe is an Executive Editor at Xtelligent Healthcare Media, covering revenue cycle management, healthcare payers, health policy, and health IT since 2016.