Regulatory Issues for Medicare Providers

Medicare is highly vulnerable to fraud, waste, and abuse. The enforcement of program payment rules, however, has raised concerns that these safeguards may have imposed too great a burden on health care providers. The proposed Medicare Education and Regulatory Fairness Act would seek to address some of these concerns by providing expedited procedures for provider appeals, new options for providers to use in repaying Medicare overpayments, protections for providers who voluntarily return overpayments or ask for a review of their claims, and new requirements for provider education. This report reviews how this proposed legislation would affect Medicare policies and procedures in (1) provider education and participation, (2) medical reviews, audits, and appeals, (3) recovery of overpayments, and (4) related legal issues.