Beginning June 1, 2015, Medicare will require all physicians and eligible providers who order Durable Medical Equipment, Prosthetics, and Supplies, or certify home health care to be enrolled with Medicare. The statute also permits the Secretary to extend these Medicare enrollment requirements to physicians and eligible professionals who order or certify all other categories of Medicare items or services, including covered Part D drugs. Accordingly, CMS will require that physicians and eligible professionals who write prescriptions for covered Part D drugs must be enrolled in Medicare, or have a valid record of opting out of Medicare for their prescriptions to be covered under Part D. This requirement will help CMS ensure that Part D drugs are only prescribed by qualified individuals. This provision is effective June 1, 2015.
Permit revocation of Medicare enrollment for abusive prescribing practices and patterns: CMS is adding the authority to revoke a physician’s or eligible professional’s Medicare enrollment if:
- CMS determines that he or she has a pattern or practice of prescribing Part D drugs that is abusive, represents a threat to the health and safety of Medicare beneficiaries, or the pattern or practice of prescribing otherwise fails to meet Medicare requirements; or
- His or her Drug Enforcement Administration (DEA) Certificate of Registration is suspended or revoked; or
- The applicable licensing or administrative body for any state in which a physician or eligible professional practices has suspended or revoked the physician or eligible professional’s ability to prescribe drugs.
Providing CMS the authority to revoke such prescribers’ Medicare enrollment will help protect beneficiaries and the Medicare Trust Fund from fraud, waste and abuse.
Read a summary fact sheet here http://go.cms.gov/Y0fV4o
