Four years after Obamacare became law, the Department of Health and Human Services (HHS) is notifying Medicare providers and suppliers of new fingerprint-based background checks. Eventually, all individuals who hold a five percent or greater stake in a Medicare supplier or provider that is categorized as “high risk” will be subject to the requirement. The provision is part of the Medicare, Medicaid, and CHIP Program Integrity Provisions (Title E) of the Affordable Care Act, and gives the HHS secretary broad discretion in applying the background check requirements depending on the potential for abuse, fraud, and/or waste.
The new requirements are spelled out in a document posted online on the website of the Centers for Medicare and Medicaid Services (CMS) last Friday. The new rules will apply to both current and future enrollees who are classified as “high risk,” the stated purpose being to weed out “bad actors” in the Medicare program and prevent any more from enrolling.
This particular document is a “News Flash” from CMS’s Medicare Learning Network and is addressed to suppliers and providers who submit claims for “Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and Home Health and Hospice (HH&H) MACs for services provided to Medicare beneficiaries.” There is no effective date or implementation date listed on the document; rather, the document states that “fingerprint-based background check implementation will be phased in beginning in 2014,” and that those affected will receive letters after which the individuals will have thirty days to comply with the finger-printing requirement. The fingerprints will be submitted to the FBI for a background check and will be stored by the government in accordance with federal requirements and FBI guidelines.
Although initially the new regulations will only be applied to providers and suppliers of “Durable Medicare Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers or Home Health Agencies (HHA),” the “high risk” category is defined at the discretion of the HHS secretary and may be expanded in the future.