WASHINGTON—Starting Aug. 1, providers considered at “high risk” for defrauding state Medicaid programs will undergo a criminal background check that includes fingerprinting.
By March 2016, all of a states’ Medicaid and CHIP providers must be ranked as having a limited, moderate or high risk of defrauding the program, the CMS says in a letter sent Tuesday to state Medicaid directors (PDF). States must repeat this process at least once every five years.
States will need to use their discretion to rank providers. Only those that pose a high risk will be required to undergo fingerprinting and background checks. The guidance comes roughly four years after the agency released a final rule on the screening, which is one of several provisions in the Affordable Care Act giving HHS new tools to crack down on Medicare and Medicaid fraud. The CMS began conducting fingerprint-based background checks for Medicare providers in August 2014.