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Missouri Properly Converted Provisionally Enrolled Medicaid Providers to Permanent Providers

Why OIG Did This Audit

In response to the COVID-19 pandemic, the Secretary of Health and Human Services temporarily waived certain Medicaid provider enrollment requirements.

Loosening of provider screening requirements increases Medicaid vulnerability to fraud by moderate and high-risk providers. Because of the speed with which established provider enrollment requirements have been waived or modified, we believe that the opportunity for abuse of the Medicaid system could result in unallowable billing, duplication of services, breach of confidentiality, identity theft, and ineffective or unsafe care.

Our objectives were to determine whether Missouri: (1) followed up with provisionally enrolled Medicaid providers to ensure that all documentation was obtained according to applicable provider screening and enrollment requirements after regular enrollment practices resumed and (2) had effective controls over the provisional enrollment process during the public health emergency for the period of March 1, 2020, through May 15, 2020.

How OIG Did This Audit

We selected a stratified random sample of 100 provisionally enrolled providers (of the 1,036 during our audit period) and reviewed their documentation to determine whether they were properly converted to permanent providers or terminated by May 15, 2020.

What OIG Found

Missouri correctly followed up with the provisionally enrolled Medicaid providers to ensure that all documentation was obtained in accordance with applicable provider screening and enrollment requirements, or that the Medicaid provider was terminated, after the regular enrollment practices resumed for all 100 sampled provisionally enrolled Medicaid providers. Missouri's provisional enrollment process involved tracking provisionally enrolled providers on a spreadsheet and terminating them if they did not provide the necessary documents required for a regular enrollment. Because we identified no errors in our sample review, we concluded that Missouri's controls over the provisional enrollment process were effective.

Missouri Comments

Missouri stated that it was pleased that no findings were identified during our sample review and added that it "remains committed to this level of work."

Filed under: Centers for Medicare and Medicaid Services