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CMS unveils provider fingerprinting program


The Centers for Medicare and Medicaid Services will require fingerprint-based background checks to catch "bad actor" providers trying to enroll in Medicare and remove those now participating, according to a Medicare Learning Network Matters article from CMS. The program is part of enhanced enrollment screening provisions of the Affordable Care Act.

Phasing in this year, the program will affect new Medicare providers of durable medical equipment (DME), prosthetics, orthotics, supplies and home health agencies. Fingerprint-based background check requirements also will apply to providers CMS deems high-risk in the future, according to a Physicians Practice blog post.

CMS will eventually require fingerprint screening on all individuals with a 5 percent or greater ownership interest in a high-risk category provider or supplier, according to CMS. Apparently the government is inching forward in using biometric science to fight fraud.

Here's how the program will work: CMS will send notification letters to affected providers with contact information for the fingerprint-based background check contractor. Providers will be required (generally just once) to pay for and undergo fingerprinting.

The contractor will collect fingerprints and send them to the FBI for processing. Within 24 hours of receipt, the FBI will compile a background history. CMS will assess the data and either approve the provider application or exercise authority to deny the application or revoke Medicare claims filing privileges.

News of fingerprint screening may not be well met by healthcare providers. "Although there are certainly good reasons to increase the scrutiny of businesses receiving reimbursement from the Medicare program," Physicians Practice noted, "this is a frightening direction for the government to push its fraud and abuse investigative authority."

Yet a steady stream of cases moving through the justice system underscore the need to make DME fraud and abuse fighting a high priority, as FierceHealthPayer: Anti-Fraud previously reported. Moreover, home healthcare has been on the law enforcement radar for years, with ACA changes addressing the perception that home health agencies are riddled with fraud.

For more:
- here's the Medicare Learning Network Matters article (.pdf)
- read the Physicians Practice blog post

Related Articles:
Biometrics take fraud fighting to new frontier
Home care, hospice fraud trends to watch
Senate panel examines Medicare fraud costs
Medical equipment fraud schemes worth watching
Criminals find veins of gold in diabetic supply benefits
CMS expands contractors' claims denial authority