Status of State Medicaid Provider Enrollment and Screening Activities

OBJECTIVE

Provider enrollment screening is a key program integrity tool for protecting Medicaid against fraudulent and abusive providers. Federal law requires State Medicaid agencies to screen providers as part of the Medicaid enrollment process. For high-risk provider types, including durable medical equipment, prosthetics, and orthotics suppliers and home health agencies, required screening activities include site visits and fingerprint-based criminal background checks. Prior OIG work has identified issues with States’ implementation of provider enrollment and screening requirements for both fee-for-service Medicaid and Medicaid managed care. During the COVID-19 public health emergency, CMS suspended certain screening requirements, which may have exacerbated the issues previously identified and presented new challenges. This study will determine the status of States’ required Medicaid provider enrollment and screening and will assess States’ standards and processes for screening.

TIMELINE

• December 16, 2024
  Announced
• Today
  Office of Evaluation and Inspections In-Progress
• Est FY2026
  Estimated Fiscal Year for Project Completion

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