Audit of Medicaid Unenrolled Providers

OBJECTIVE

To strengthen Medicaid provider enrollment, the 21st Century Cures Act (Cures Act) required that all providers that serve Medicaid beneficiaries enroll with their State Medicaid agency effective January 1, 2017, for Medicaid FFS and January 1, 2018, for Medicaid managed care organizations (MCOs). In addition, the Cures Act required that no Federal financial participation be paid for managed care expenditures when States have not complied with the requirement to enroll MCO network providers. States must also return to CMS the Federal share of overpayments associated with unenrolled fee-for-service (FFS) providers. We will determine whether the State agencies complied with these Federal requirements and prohibited payments associated with providers that were not enrolled in their Medicaid FFS and managed care programs.

TIMELINE