CMS Affiliation Rule Enables 10-Year Medicare Enrollment Bars for Physicians Without Direct Violations

Under current Medicare enrollment regulations, physicians can face up to 10-year exclusions from treating Medicare patients based solely on affiliation with another provider or supplier that has compliance issues, even when the physician has no personal history of fraud, improper billing, or disciplinary actions. The affiliation rule allows CMS to deny or revoke enrollment based on an individual's relationship with an entity that has been sanctioned or excluded. This administrative action does not require proof that the physician submitted improper claims or engaged in wrongdoing. The rule particularly affects hospice medical directors and other physicians in administrative or leadership roles where formal affiliations are documented.

Managed Care