On January 29, 2017, the Centers for Medicare and Medicaid Services (CMS) announced a temporary moratorium on enrolling Part B non-emergency ambulance providers/suppliers and home health agencies, subunits and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania and New Jersey. CMS is taking this measure “to prevent and combat fraud, waste and abuse.” The moratorium also extends to the Medicaid and Children’s Health Insurance Programs (CHIP). According to CMS, the action is taken pursuant to Sections 1866(j)(7), 1902(kk)(4), and 2107(e)(1)(D) of the Social Security Act and CMS regulations at 42 CFR 424.570, which permit a temporary moratorium on the enrollment of Medicare, Medicaid, and/or CHIP providers and suppliers (including categories and/or particular geographic locations or both) where there is a significant potential for fraud, waste, or abuse.
In the announcement, CMS provided its rationale for imposing the moratorium – citing generally to a methodology involving consulting with law enforcement (the Office of Inspector General and Department of Justice) on trends and activities, and confirming this by analyzing CMS data. CMS also provided assurance that it had determined that access to care would not be a problem for beneficiaries. CMS explained that the basis for imposing the moratorium was not subject to judicial review. However, CMS also noted that the regulations did not limit the right of particular providers or suppliers to seek review of final agency decisions that the temporary moratorium applies to them.