Warning: Medicare Contractors Enforcing Fingerprint Requirements

The passage of the Patient Protection and Affordable Care Act (ACA) heralded a new era for provider enrollment and revalidation by enhancing provider and supplier screenings. The Centers for Medicare & Medicaid Services (CMS) now requires certain providers to be fingerprinted in order to continue participating in the Medicare program. Medicare contractors (MACs) have been sending notices to impacted providers and suppliers advising them to complete fingerprinting within a specified time-frame.

The ACA and the implementing regulation require that a Medicare contractor conduct a fingerprint-based criminal history record check of the Federal Bureau of Investigation’s Integrated Automated Fingerprint Identification System on all individuals who maintain a 5 percent or greater direct or indirect ownership interest in a “high risk” provider or supplier.

Individuals impacted by this requirement may include the following:

  • individuals with a payment suspension within the last 10 years;
  • individuals who have been excluded from Medicare or any Federal Health Care program;
  • individuals who had their billing privileges revoked by CMS within the previous 10 years;
  • individuals who have been subject to any final adverse action in the previous 10 years;
  • individuals who have been terminated or were otherwise precluded from billing Medicaid;
  • where CMS lifts a temporary moratorium for a particular provider or supplier type and a provider or supplier that was prevented from enrolling based on the moratorium, applies for enrollment as a Medicare provider or supplier at any time within 6 months from the date the moratorium was lifted; or
  • 5% or greater direct or indirect owners or DMEPOS suppliers and Home Health Agencies

Failure to respond within the 30 days provided in the MAC notices may result in provider/supplier revocation. Based on our experience, Medicare contractors strictly enforce the 30 days in the fingerprinting notice. CMS has selected Accurate Biometrics as its fingerprinting contractor.

If you have questions about the new Medicare fingerprinting requirement, Medicare/Medicaid enrollment, revalidation, revocation, exclusion or have other health law questions, please contact our office.