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Status Update on States' Efforts on Medicaid-Provider Enrollment

Provider enrollment is the gateway to billing the Medicaid program. If this gateway is not adequately safeguarded, Medicaid is at risk of fraud, waste, and abuse. Previous Office of Inspector General (OIG) work found that many States had yet to complete fingerprint-based criminal background checks and site visits. OIG made recommendations to the Centers for Medicare & Medicaid Services (CMS) to assist States with completing these activities. CMS concurred with OIG's recommendations and has provided assistance to States. However, CMS continues to extend the deadline for completion of fingerprint-based criminal background checks, indicating that States are still working on provider enrollment. For this Status Update, we will determine the extent to which States have completed fingerprint-based criminal background checks and site visits. In addition, we will ask States and CMS about challenges that prevent States from completing fingerprint-based criminal background checks and site visits.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
January 2018 Centers for Medicare & Medicaid Services Status Update on States' Efforts on Medicaid-Provider Enrollment Office of Evaluation and Inspections OEI-05-18-00070 2018

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