–For services before January 1, 2010, all claims must be filed by December 31, 2010. For services after January 1, 2010, the new 12-month limit applies.
–Physicians who order Medicare-eligible services must themselves be Medicare enrolled.
–Physicians must keep documentation about the referral or lose eligibility.
–A face-to-face encounter with the patient is required before physicians may certify eligibility for home health services or durable medical equipment under Medicare, the encounter has to be within 6 months of the order. If this is successful in reducing fraud and abuse, the Secretary may require encounters for other services in the future.
–For denying or delaying access in the face of an audit, a provider can be fined $15,000 for each day. The provider can also be fined $50,000 for each false record or statement.
–For Medicare Advantage and Part D plans, anyone who enrolls or transfers an individual in a plan without his knowledge for the purpose of earning a commission can be fined or otherwise penalized.
–For durable medical equipment. prosthetics, orthotics and supplies, the rate charged must be competitively price bid by 2016.
–The Recovery Audit Program may be used to recover Medicare overpayments. Under this program, States contract with independent companies to conduct audits, and their cost is recovered from the monies received during the audits.
–If a provider is terminated under Medicare, s/he also loses his provider status under Medicaid.