–The HHS Secretary may deny enrollment to anyone who poses an undue risk of fraud, waste, or abuse. and a moratorium may be put into place.
Each provider will establish a compliance program including “core elements” for their industry or practice.
–The State must now report to the Secretary, any criminal or civil convictions, sanctions, or negative licensure actions, and other adverse provider actions. The HHS Secretary must notify the State within 30 days of any provider terminations.
–To pursue any law enforcement and oversight activities, the Inspector General and the Attorney General can have access to claims and payment data for Medicare, MedicAid, and CHIP.
–Overpayments must be flagged and the program must be notified within 60 days of receipt.