I. Overview of CMS’s Existing Revocation Authorities:One of the principle tools used by CMS to protect the Medicare program from the participation of unscrupulous providers is its regulatory authority to revoke a provider’s Medicare billing privileges. In recent years, CMS’s regulatory authority to deny a provider’s enrollment OR to revoke a participating provider’s billing privileges has been greatly expanded. In addition to expanding the regulatory bases that CMS may rely upon when exercising its revocation authority, the 2019 Final Rule also extended the period that a revoked healthcare provider can be barred from reenrolling in the Medicare program from THREE YEARS to TEN YEARS. A summary overview of the current expanded list of reasons for revocation is discussed in an article entitled “Home Health Revocation Actions by Medicare are Expanding Around the Country.” 
II. CMS Proposes to Expand its Revocation Authorities to Include the Exclusion of Virtually Anyone Associated with the Provided
Earlier this year, CMS published a Proposed Rule in the Federal Register that addresses planned changes to the 2022 physician fee schedule, a number of other regulatory issues, and a significant expansion of CMS’s authority to revoke a Medicare provider’s billing privileges. The proposed changes to CMS’s revocation authorities are found in 42 CFR §424.530(a)(2) – Denial of Enrollment in the Medicare Program, and 42 CFR §424.535(a)(2) – Revocation of Enrollment in the Medicare Program.Under the existing multi-part regulations, CMS may deny a provider’s application for enrollment OR revoke a provider’s existing enrollment in the program and their associated Medicare billing privileges if the provider or any owner, managing employee, authorized or delegated official, medical director, supervising physician, or other health care personnel of the provider has been excluded from the Program by the OIG. While this would seemingly be sufficient to protect the program and its beneficiaries, CMS proposes to expand the revocation authority as follows:
- First, CMS proposes to expand the categories of parties within the purview of CMS’s denial and revocation provisions to include excluded administrative or management services personnel who furnish services payable by a Federal health care program, such as a billing specialist, accountant, or human resources specialist.
- Second, CMS also proposes to change the existing language from “other health care personnel” furnishing Medicare Services who must be disclosed “on the enrollment application” to ANY “other health care or administrative or management services personnel furnishing services” regardless of whether they must be disclosed on the enrollment application or not.
- Third, CMS proposes to modify the scope of 42 CFR §424.535(e) so that the language concerning other personnel furnishing Medicare reimbursable services is expanded to include “other health care or administrative or management services personnel furnishing services payable by a federal health care program.”