US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P)
Denial, revocation, deactivation, stay, rebuttals and appeals (424.530 to 424.547) – US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P)

US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P) 424.542,424.547: Physicians and practitioners with a detrimental felony within 10 years may not order, certify, refer or prescribe Medicare items, and those enrolled on Form CMS-855O must appear on a claim at least once in 12 months or be deactivated

A physician or eligible professional, enrolled or not, who has had within the previous 10 years a felony conviction that CMS determines is detrimental to the best interests of Medicare and its beneficiaries may not order, refer, certify or prescribe Medicare-covered services, items or drugs, and Medicare does not pay for anything so ordered, referred, certified or prescribed. CMS may deactivate the ordering, certifying and referring ability of a physician or practitioner enrolled via Form CMS-855O solely for that purpose who has not been listed as the ordering, certifying or referring individual on a Part A or B claim in the previous 12 consecutive months; reactivation requires recertifying the enrollment information, supplying missing information and compliance (or, at CMS's option, a complete new Form CMS-855O), is effective on the contractor's receipt of the submission later approved, and no ordering, certifying or referring may occur while deactivated.

Maintained by Gerard Blokdyk

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