The Patient Protection and Affordable Care Act (PPACA) contains several provisions aimed to reduce fraud and abuse in home health and Durable Medical Equipment (DME) programs, which CMS and OIG consider to be high risk programs. Effective July 1, 2010, physicians who order covered home health or DME services must be enrolled in Medicare (§ 6405).
Physicians who provide home health and DME services must maintain records of referring physicians, and CMS is authorized to revoke the enrollment of physicians who fail to provide those records upon request (§ 6406).
Finally, § 6407 requires that physicians who certify home health services and physicians who order DME services, along with any other providers as determined by the secretary (must have conducted face to face encounters, subject to certain telehealth exceptions) in order to order or certify such services. These requirements will be effective as of January 1, 2010, which means they are effective already. You can download a PDF of Sections 6405-6407 for more information.
