States' Enrollment Safeguards for Select Medicaid-only Provider Types
Federal rules require enhanced screening for providers and suppliers seeking initial enrollment, reenrollment, or revalidation in Medicare, Medicaid, and CHIP according to risk. In 2016, OIG found opportunities for improvement with enhanced provider screenings in Medicare and Medicaid. When only Medicaid recognizes a provider type (e.g., personal care services and nonemergency medical transportation services), States are responsible for assessing the provider types risk for fraud, waste, and abuse according to the risk the provider poses (42 CFR 455.450; 76 Fed. Reg. 5862 (February 2, 2011)). We will review States enrollment screening activities for select Medicaid-only providers types and any challenges States face in screening Medicaid-only provider types.
|Announced or Revised||Agency||Title||Component||Report Number(s)||Expected Issue Date (FY)|
|Nov-16||Centers for Medicare & Medicaid Services||States' Enrollment Safeguards for Select Medicaid-only Provider Types||Office of Evaluation and Inspections||OEI-05-16-00460||2018|