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Fingerprint-Based Security Measures for Medicare Providers

The recently published 2015 Office of Inspector General (OIG) Work Plan indicates that enhanced provider security screening is now in place and will be reviewed by the OIG.


In August, the Centers for Medicare and Medicaid Services (CMS) began implementation of 42 CFR Part 1007, which was originally published in the Federal Register in 2011.   The new security provision was implemented on August 6, and includes fingerprinting-based background checks.  The contract for fingerprinting was awarded to Accurate Biometrics, in Chicago, Illinois

Medicare Administrative Contractors (MACs) have started sending letters to providers, listing all owners who require fingerprinting.  Providers must respond within 30 days from the date of the letter.  Failure to respond could result in either revocation of Medicare billing privileges or denial of Medicare enrollment applications.

These security background checks are now required for all individuals with a 5% or greater ownership interest in an organization and those that fall into the “high-risk” category.  High risk individuals include newly-enrolled Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) suppliers and home health care agencies (HHAs).

CMS is implementing other new measures in an effort to prevent fraud, waste and abuse resulting from weaknesses in the Medicare enrollment process.  These include background checks and an automated provider screening process for providers and home health agency workers.  For more information, see MLN Matters® Number SE1417.

Nancy Clark is a Manager in the Health Care Services Group. Her expertise focuses on coding and documentation audits, which includes chart review and report compilation.

Contact Nancy B.

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