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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

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201