The Centers for Medicare & Medicaid Services (CMS) announced that it will begin implementing the fingerprint-based background checks for providers and suppliers in certain risk categories.
Section 6401 of the Affordable Care enhanced the screening requirement for newly enrolling and revalidating providers and suppliers and instructed the Secretary of Health and Human Services to determine the appropriate level of screening required based on the risk of fraud, waste and abuse a provider or supplier presents to the Medicare Program. Regulations promulgated pursuant to this Act identified newly enrolling DMEPOS and home health agencies as high risk requiring the submission of fingerprints for a national background check for all individuals that directly or indirectly maintain a 5% or greater ownership interest in the supplier. High risk screening levels also apply to providers or suppliers whose risk levels have been adjusted based on their prior history with the Program.
Until now, however, the fingerprint requirement was not enforced as the government was selecting and coordinating with contractors to implement this enhanced screening requirement.
CMS is now implementing the fingerprinting requirement to all applicable providers throughout 2014 although no specific start date has been announced. The effected providers and suppliers will be notified by their MACs and will be given 30 days from the date of the notification letter to be fingerprinted. Providers and suppliers will work with Fingerprint Based Background Check Contractor (FBBC) during this screening process. The FBBC will provide the names and locations for suppliers to get fingerprinted, forward the fingerprints to the FBI to run background checks upon receipt of the same from suppliers, and thereafter, provide a fitness report to CMS based on the law enforcement information obtained.
Based on the information received, CMS will make the final determination regarding each provider or supplier. The agency will compare the information from the law enforcement data against information in provider or suppliers enrollment or revalidation applications and deny or revoke Medicare billing privileges if false or misleading information is discovered. The regulation also provides that individuals who are required to but fail to timely submit the fingerprints will also have its billing privileges denied or revoked.
If you have questions about the fingerprint requirement, enrollment or revalidation, risk screening levels, Medicare participation or revocation, or need other legal assistance, please contact our office.