Medicare Providers and Suppliers Deemed "High Risk" Must Submit to Fingerprint-Based Background Checks

Friday, May 9, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare and Medicaid Services (CMS) is enforcing fingerprint-based background checks for Medicare suppliers and providers designated as "high risk." As a requirement of the Affordable Care Act (ACA), CMS must improve the screening for those Medicare suppliers and providers. According to CMS, all newly enrolling home health agencies (HHAs) and durable medical equipment (DME) suppliers are high risk. All persons with a five percent (5%) or greater ownership interest in either an HHA or DME will be subject to the fingerprint-based background checks. CMS states that this program will be phased in the beginning of 2014.

To learn more on these background checks from CMS, click here.


How Providers and Suppliers are Notified.


According to CMS, Medicare Administrative Contractors (MACs) will notify providers and suppliers when the fingerprint requirement is applicable to them. The owners will have 30 days from the date of the notification letter to be fingerprinted. The MAC will direct the owners to contact the CMS Fingerprint-Based Background Check Contractor (Contractor). The Contractor will offer the individuals three locations where they can be fingerprinted. Individuals will be responsible for all costs associated with fingerprinting.

The Contractor will forward the fingerprints to the Federal Bureau of Investigation (FBI) to complete a background check and send the results back to the Contractor. The Contractor will provide a recommendation to CMS. Depending on the results of the test, CMS  can deny the Medicare supplier or provider's enrollment application or revoke billing privileges.


Verify Correct Address on File.

Again, MACs will be notifying providers and suppliers when the fingerprint requirement is applicable. Be sure they have a correct mailing address on file. When the MACs receive notice that the notice was sent to an invalid address, Medicare will deactivate that provider's number. All practitioners are cautioned to verify through the Medicare Provider Enrollment Chain Ownership System (PECOS) or by calling their carriers. It is important to respond immediately and completely to any such revocation notice you receive by at least two different proveable methods (such as U.S. certified mail with a return receipt requested and/or Federal Express with a tracking number).

In a recent case of this nature, we promptly provided a well-thought-out, documented corrective action plan (CAP), requested a supervisory reconsideration and requested an appeal hearing, all at the same time. The carrier promptly reversed its decision to revoke the Medicare provider status of the client.

Prompt, precise and documented action is required to protect an individual's rights and prevent an incorrect decision by a government agency or contractor.


CMS is Coming up with Other Ways to Fight Fraud.

These new rules for fingerprint background checks apply to both current and future enrollees who are classified as high risk. The purpose of the fingerprint-based background checks are to eliminate people committing fraud in the Medicare program and prevent any more from enrolling.

The ACA seeks to improve anti-fraud and abuse measures by focusing on prevention rather than the traditional “pay-and-chase” model of catching crooks after they have committed fraud.
By knowing that the government is beefing up measures to fight healthcare fraud, providers and suppliers can attempt to avoid practices that are likely to lead to audits. Additionally, providers can be prepared for potential audits by increasing their documentation and compliance efforts.


Contact Health Law Attorneys Experienced in Home Health Agency and Durable Medical Equipment Supplier Cases.

The Health Law Firm and its attorneys represent home health agencies, home health agency employees and durable medical equipment suppliers in a number of different matters. These matters include incorporation, preparing contracts, defending the facility against malpractice claims, licensing and regulatory matters, administrative hearings, and routine legal advice.

If Medicare deactivates your provider number, it is important to respond immediately and completely. The Health Law Firm's attorneys have experience putting together corrective action plans (CAPs), requesting supervisory reconsiderations and requesting appeal hearings. Prompt, precise and documented action is required to protect an individual's rights and prevent an incorrect decision by a government agency or contractor. We do not ever recommend that you attempt to do this yourself. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

What do you think about the fingerprint-based background checks for high risk Medicare suppliers and providers? Do you think this is helping to deter healthcare fraud? Please leave any thoughtful comments below.


Sources:

Topinka, Ralph. "CMS (Centers for Medicare and Medicaid Services) Implements Fingerprint-Based Background Checks." The National Law Review. (April 17, 2014). From: http://www.natlawreview.com/article/cms-centers-medicare-medicaid-services-implements-fingerprint-based-background-check

Bier, Jeryl. "Feds Begin Fingerprinting 'High Risk' Medicare Providers and Suppliers." The Weekly Standard. (April 15, 2014). From: http://www.weeklystandard.com/blogs/feds-begin-fingerprinting-high-risk-medicare-providers-and-suppliers_786924.html

CMS. "Implementation of Fingerprint-Based Background Checks." CMS. (April 2014). From: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1417.pdf


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


Tag Words: Centers for Medicare and Medicaid Services, CMS, Medicare providers, high-risk Medicare providers, Department of Health and Human Services, HHS, fingerprint background checks, Affordable Care Act, ACA, home health agencies, HHA, durable medical equipment (DME) supplier, Medicare Administrative Contractor, MAC, Federal Bureau of Investigation, FBI, Fingerprint-Based Background Check Contractor, defense attorney, defense lawyer, HHA attorney, HHA lawyer, DME supplier attorney, DME supplier lawyer, Medicare provider number, health law firm, corrective action plan, The Health Law Firm


The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
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5/9/2014

Comments:

Response to: Medicare Providers and Suppliers Deemed "High Risk" Must Submit to Fingerprint-Based Background Checks
Saturday, December 27, 2014
Ingrid says:

There is so much fraud within our own politicians, this is just a smoke screen. Back in the 1980's I worked with a physician that put a DME company under his sister's name to defraud Medicare. The problem comes in review of medical records and billing.

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