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)
Removed	Centers for Medicare & Medicaid Services	States' Enrollment Safeguards for Select Medicaid-only Provider Types	Office of Evaluation and Inspections	OEI-05-16-00460	Not Applicable