CMS to Begin Fingerprint-based Background Checks
April 16, 2014 08:25 AM
The Centers for Medicare & Medicaid Services (CMS) has announced its intention to begin finger print based background checks. Fingerprint-based background checks is a requirement, under §424.518, for any individual with a five percent or greater ownership interest in a provider or supplier that falls under the “high” risk category. High level risk category providers, include newly enrolling home health agencies, newly enrolling durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers, and any provider and supplier that CMS has elevated to the high risk category.
CMS delayed the implementation of finger print background checks until now for logistic reasons and will phase it in beginning in 2014. Initially, not all providers and suppliers in the “high” level of risk category will be a subject to the fingerprint-based background check requirement. Once fully implemented though, the fingerprint-based background check will be completed on all individuals with a 5 percent or greater ownership interest in a provider or supplier that falls under the high risk category.
CMS may adjust a particular provider or supplier’s screening level from “limited” or “moderate” to “high” if any of the following occur:
1. CMS imposes a payment suspension on a provider or supplier at any time within the last 10 years;
2. The provider or supplier:
Has been excluded from Medicare by the Office of Inspector General; or
Had its billing privileges revoked by a Medicare contractor within the previous 10 years and is attempting to establish additional Medicare billing privileges by:
Enrolling as a new provider or supplier; or
Obtaining billing privileges for a new practice location
Has been terminated or is otherwise precluded from billing Medicaid
Has been excluded from any Federal health care program
Has been subject to any final adverse action (as defined in §424.502) within the previous 10 years.
3. 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.
Applicable providers and suppliers will receive a notification letter of the fingerprint requirements from their MAC. Individuals will have 30 days from the date of the notification letter to be fingerprinted.
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