Be Aware of the New Fingerprint-Based Background Check Requirement for Certain Medicare Suppliers and Providers

by Chambliss, Bahner & Stophel, P.C.
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The Center for Medicare & Medicaid Services ("CMS") recently posted on its website an article indicating that, as part of enhanced screening provisions in the Affordable Care Act, it will phase in a new fingerprint-based background check requirement for certain Medicare providers and suppliers, including home health agencies ("HHAs") and Durable Medicare Equipment, Prosthetics, Orthotics and Supplies ("DMEPOS") suppliers, beginning in 2014. 

The new program is ostensibly aimed at detecting bad actors who are attempting to enroll or are already enrolled in the Medicare program. Specifically, it applies to providers and suppliers deemed "high risk" and will require, among other things, that all individuals who maintain a 5% or greater direct or indirect ownership interest in a high risk entity submit a set of fingerprints for a national background check conducted by the Federal Bureau of Investigation ("FBI"). The high risk category applies to all newly enrolling HHA and DMEPOS providers and suppliers. It also applies to a variety of other providers and suppliers who have been elevated to the high risk category for other reasons specified by regulation, such as having payment suspended by CMS at any time in the prior ten (10) years, having been excluded from a federal health care program or applying for enrollment within six (6) months from the date that CMS lifted a temporary moratorium. 

Affected individuals must provide fingerprints upon submission of a Medicare enrollment application or within thirty (30) days of receiving a request from a Medicare contractor. Moreover, the affected individuals will incur the cost of having their fingerprints taken, which will vary by location. Once fingerprints are collected by Fingerprint-Based Background Check Contractors ("FBBCs"), they will be forwarded to the FBI for processing. The FBI will then share background history with the applicable FBBC, which will review the information and provide a fitness recommendation to CMS. CMS will use the information to make enrollment decisions. All fingerprint data will be stored in accordance with federal and FBI requirements and guidelines. Significantly, CMS has indicated that not all providers and suppliers deemed high risk will be part of the fingerprint-based background check requirement initially.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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