Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
determination is upheld on appeal, we will initiate a
recovery action.
Accordingly, we proposed to add a new §424.530(a)(6)
and (a)(7) to deny enrollment applications for additional
Medicare billing privileges if the physician or NPP
organization or individual practitioner has an active
payment suspension or has an existing overpayment that has
not been repaid. We proposed to allow a Medicare FFS
contractor to deny enrollment applications from those
authorized officials, delegated officials, owners, and
individual practitioners that own a supplier or provider at
the time of filing until such time as the suspension has
been terminated or the Medicare overpayment has been repaid
in full. Specifically, we proposed to deny enrollment to
any current owner (as defined in §424.502), physician, or
NPP, who is participating in the Medicare program and is
under a current Medicare payment suspension.
We stated that we believe that the change to our
denial policy would help protect the Medicare program from
unscrupulous or problematic physician and NPP organizations
and individual practitioners. Moreover, we believe this
change would: (1) allow Medicare FFS contractors to
improve customer service to all providers and suppliers
that are already enrolled in the Medicare program; (2)
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