Beginning later this year, Centers for Medicare & Medicaid Services (CMS) will begin using a Fingerprint-Based Background Check Contractor (FBBC) to help keep patients safe through enrollment screening. This process will be put in place in order to comply with the implementation of the Affordable Care Act (ACA).
The ACA requires that the Department of Health and Human Services establish screening procedures for providers and suppliers participating in federal health care programs. These programs specifically include:
- Children’s Health Insurance Program
Other safety measures including unannounced site visits and background checks—to be used based on the level of risk—were also added. CMS has three levels of risk: limited, moderate, and high. Every provider and supplier is assigned a level. Those who maintain a 5 percent or higher ownership interest in a provider or supplier (whether direct or indirect) is placed in the high risk category. These individuals include:
- Newly-enrolling home health agencies (hhas)
- Newly-enrolling durable medical equipment, orthotics, prosthetics, and supplies (DMEPOS) suppliers
These individuals are also subject to a fingerprint-based criminal history report through the FBI Integrated Automated Fingerprint Identification System. Not every high-risk individual will take part in the fingerprint-based background check requirement initially; however, eventually the fingerprint-based background check will be completed on all individuals that fall under the high-risk category.
In March 2014, CMS awarded a $4.19 million FBBC contract to Accurate Biometrics, Inc. They delayed the starting date of the fingerprinting system until they could obtain additional sub-regulatory guidance. Following this award, CMS issued a provider update announcing that it intends to phase in the fingerprint-based background check implementation beginning in 2014.
Medicare Administrative Contractors (MACs) will notify (by mail) those who will be affected by the fingerprint requirements. Afterwards, applicable individuals will have 30 days to be fingerprinted at one of the three FBBC designated locations. Once completed, the fingerprints will be sent to the FBI for a complete background history. The data that the FBBC has will be used to provide a fitness recommendation to CMS about whether the criminal history report indicates any enrollment violations or in any other way fail to meet the requirements/guidelines established by CMS.
In addition, the fingerprinting policy will also apply to those who are elevated to the high-risk category. This can include:
- providers/suppliers coming back to the Medicare fee-for-service program
- providers which have been subject to a payment suspension, exclusion, or revocation
Unfortunately, this plan may cause some headaches for both those who have to work for and go through the system. There is likely to be some individual who will not relish the idea of the fingerprinting process. Moreover, the process will undoubtedly provide opportunities for administrative mistakes.
Background checks (for various purposes) will continue to be of importance to our society. Background checks are in place to make society safer. For more information about background check policies—and for software to help you or your business perform background checks—please visit InnovativeBCS (http://www.innovativebcs.com).