Reading CRUSH Before It Arrives: What CMS’s Recent Fraud Announcements May Signal—and Why Legitimate Molecular Laboratories Should Care
CMS’s proposed Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) rule remains under review at the Office of Management and Budget. CMS transmitted the proposed rule on August 7; OIRA lists it as a proposed rule, with no statutory deadline and without an “economically significant” designation. (RegInfo)
The public starting point was CMS’s unusually broad February request for information. The RFI ranged across provider enrollment, payment suspensions, ownership and identity verification, Medicare Advantage and Part D, laboratories, DMEPOS, artificial intelligence, claims deadlines and other program-integrity tools. It specifically asked how CMS could gain more authority and flexibility to intervene quickly against suspected fraud and how analytics could be connected more effectively with those interventions. (Federal Register)
Earlier background on the CRUSH initiative and its arrival at OMB is available in Discoveries in Health Policy: CRUSH Reaches White House / OMB and CRUSH at OMB: The Next Stage of a Twenty-Year Medicare Anti-Fraud Campaign.
While CRUSH has been at OMB, CMS has issued two unusually prominent anti-fraud announcements involving precisely two sectors emphasized in the RFI. On August 28, CMS announced more than $1.6 billion in laboratory-related enforcement actions. On September 8, it announced action involving $3.4 billion in suspected DMEPOS billing. (Centers for Medicare & Medicaid Services)
A press release is not a leaked regulation.
