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DME Suppliers and Home Health Agencies Now Subject to Fingerprint–Based Background Checks

on Thursday, 8 May 2014 in Health Law Alert: Erin E. Busch, Editor

Via Medicare Learning Network (MLN) article, CMS announced its implementation of finger-print based background checks as part of the Heightened Medicare Enrollment Standards set out in Section 640 of the Affordable Care Act. (See MLN Matter Number SE1417.) The more intensive screening will be phased in during 2014. When fully implemented, fingerprint background checks will be completed for all individuals with a five percent or greater ownership interest in a provider or supplier that falls into a “high risk” category.


The MLN Article notes that “the high level of risk category will be applied to providers and suppliers who are newly enrolling Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers or Home Health Agencies (HHAs). It will also apply to high risk providers and suppliers who have been elevated to the high risk category in accordance with enrollment screening regulations.”


The phasing in will be accomplished by direct notification from the Medicare contractor to those providers and suppliers who will be required to be fingerprinted in the initial phase. The notification letter will provide a Fingerprint-Based Background Check Contractor (“FBBC”) which must be contacted prior to fingerprinting in order to make sure that fingerprints are properly submitted to the FBI and results forwarded to CMS. When the provider or supplier contacts the FBBC, it will provide at least three fingerprint locations in the enrollee’s locale.


Fingerprints may be submitted electronically (which is preferred) or by using the FD-258 card. When the FD-258 card is used, the FBBC will convert the paper card to an electronic submission to the FBI. The FBI will compile a background history based on the fingerprints and submit a report to the FBBC. CMS will review each record, make a determination and notify individual providers or suppliers if the assessment of the fingerprint-based background check results in denial of an enrollment application or revocation of existing Medicare billing rights.


Questions about the new background checking process should be directed to the appropriate Medicare contractor.

Julie A. Knutson

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