Medicare Background Checks

Implementation of fingerprint-based background checks for Medicare Provider Enrollment

As part of the enhanced provider enrollment screening provisions of the Affordable Care Act (ACA) the Center for Medicare and Medicaid Services (CMS) is implementing fingerprint-based background checks for providers and suppliers in the “high” level risk category.  Initially, the new screening provisions will apply to newly enrolling DMEPOS suppliers, Home Health Agencies, and other providers and suppliers who have been specifically designated as high risk.

The fingerprint-based background checks will apply to all individuals with a 5% or greater ownership in an enrolling provider/supplier.  Once fully implemented, all individuals with 5 percent or more ownership in a high risk category supplier will be required to undergo fingerprint based background checks.

Fingerprints are preferred in electronic format from a finger-print based background check contractor (FBBC), but paper cards can be accepted on the standard federal form.  Providers will incur the cost of fingerprinting.

CMS will notify providers of the requirement and the provider will have 30 days from receipt of the notification to submit the information.  The notification letters will identify FBBC’s in the jurisdiction of the provider.  The provider will be responsible for the cost of fingerprinting.

For more detailed information, read the latest Medicare Learning Network article here. Details of the provision can also be found on the electronic code of federal regulations.