OIG Report on Criminal Background Checks to Mitigate Medicaid Fraud

The federal government requires all states to conduct risk-based screening activities as part of their processes for enrolling providers in Medicaid. Screening requirements vary by state and by risk category to which the provider is assigned.  Requirements include verification of licenses, fingerprint requirements, criminal background checks and site visits. The original deadline was June 2016, but this was delayed to July 2017 and again to July 2018.  A recent Office of Inspector General (OIG) survey of all 50 states and the District of Columbia requested information on implementation and challenges faced in meeting compliance.  The report found that 18 states missed implementation deadlines for background checks and 13 states had still not implemented requirements as of January 2019.

As a result, the OIG recommends that all states fully implement fingerprint-based criminal background checks and amend guidance so states cannot forgo this requirement unless Medicare has already conducted such checks.

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