Fraud and abuse: New regulations proposed for anti-markup; CMS proposes to tighten fraud and abuse rules

Why This Topic Matters

The proposals could affect how common physician, group practice, imaging, and hospital arrangements are structured and billed under Medicare. Readers who manage referral relationships, service contracts, or diagnostic testing operations will want to understand the scope of the proposed changes and potential compliance implications.

Article Sections

1. CMS proposes to tighten fraud and abuse rules

   Introduces the proposed regulatory changes and frames the article’s focus on Medicare fraud and abuse policy for the 2008 Physician Fee Schedule.

2. Broadened anti-markup provisions

   Discusses proposed changes to anti-markup policy and the types of practice arrangements that could be affected.

3. Redefining ‘entity’

   Explains the proposed revision to the definition of entity and its connection to Stark-related referral and billing structures.

4. Unit-of-service arrangement restrictions

   Summarizes proposed limits on certain per-use payment arrangements involving imaging equipment and related service relationships.

5. Predetermined percentage pay arrangements

   Covers CMS’s proposed treatment of percentage-based payment arrangements and the broader fraud and abuse concerns behind the revision.

6. IDTFs

   Outlines proposed changes affecting independent diagnostic testing facility requirements, supervision, and shared-space arrangements.

7. Other proposals

   Lists additional proposed changes touching on malpractice subsidy treatment, ownership and investment interests, compensation relationships, and timing issues for noncompliant financial relationships.