CMS readying for background checks

Wednesday, April 16, 2014

WASHINGTON – CMS is moving forward with fingerprint-based background checks for certain DME and home health and hospice providers.

The agency announced in a Medlearn Matters Article this week that it will phase in implementation of background checks for high-risk providers starting this year.

“The fingerprint-based background checks will be used to detect bad actors who are attempting to enroll in the Medicare program and to remove those currently enrolled,” CMS states in the article.

Once fully implemented, the background checks will be completed on all individuals with a 5% or greater ownership interest in a provider that falls under the high-risk category. This category applies to DME and home health and hospice providers who are newly enrolling in Medicare, and those who have been elevated to the category in accordance with enrollment screening regulations.

The article states that affected providers will receive notification of the fingerprint requirements from their DME MAC. The letter will include contact information for the fingerprint background check contractor (FBBC). Individuals will have 30 days from the date of the letter to be fingerprinted and the FBBC will provide at least three locations to be fingerprinted. Individuals are responsible for the costs of the background check, which may vary by location.

A provision in the Affordable Care Act called for enhanced screening of providers to prevent fraud and abuse. CMS published a final rule setting the screening levels in 2011.

CMS was expected to select a contractor for the program in February of this year.