Fingerprinting of High-Risk HHA and DMEPOS Owners to Begin

CMS is continuing to implement program integrity measures on home health agencies (HHA) and durable medical equipment prosthetics, orthotics and supplies (DMEPOS) suppliers as authorized under the Affordable Care Act (ACA).  Beginning on August 6, 2014, any individual with a 5 percent or greater ownership share of an HHA or DMEPOS supplier enrolled in Medicare as of  March 25, 2011 must have his or her fingerprints taken and a criminal background check conducted based on those fingerprints.  In a Final rule issued on February 2, 2011 these providers were categorized as “high-risk” by CMS.  In addition, CMS is extending moratorium on the opening of new home health agencies in Chicago, Dallas, Miami, Houston, Detroit and Fort Lauderdale and moratorium on new Part B ambulance suppliers in Houston and Philadelphia until December 31, 2014.

Fingerprinting. The fingerprinting will be conducted in stages, according to a Medicare Learning Network (MLN) Matters posting published by CMS.  Not all high-risk HHAs and DEMPOS will part of the first phase of the fingerprinting and background check requirements.  Medicare Administrative Contractors (MACs) will be sending out a notice to those HHAs and DEMPOS owners that will need to be fingerprinted.  All of the owners of an HHA or DEMPOS that are notified will have 30 days from the date of the notice to be fingerprinted.  Individuals being fingerprinted have the responsibility to ensure that their fingerprints are accurately and correctly forwarded to the FBI, which will be conducting the background check. Individuals can contact the provider administering the fingerprinting program via the web at www.cmsfingerprinting.com to learn how to accurately and correctly get this information to the FBI.

The fingerprinting requirements were included in sec. 6401(a)(3) of the ACA, and the high-risk categorization was adopted in the February 2011 Final rule. In that Final rule CMS adopted 42 C.F.R. 424.518 which established the categories of risk.  The same section of the ACA gave CMS the authority to place moratoria on the enrollment of new providers in categories designated as higher risk.

Moratoria. The moratoria on the enrollment of new HHAs or Part B ambulance suppliers in a number of counties across the U.S. were extended until December 31, 2014 by a Final rule issued by CMS on August 1, 2014. Originally the moratoria  on enrollment of new  HHAs in the Chicago and Miami metropolitan areas and  new Part B ambulance suppliers in Houston with a Notice issued on July 31, 2013.  The moratoria in those counties were extended  and expanded to include HHA suppliers in Detroit,  Fort Lauderdale, Dallas, Houston and surrounding counties and Part B ambulance suppliers in Philadelphia by a Notice published on February 4, 2014.

In each case CMS consulted with local law enforcement to make its determination. In both Chicago and Miami the number of HHAs was found to be much higher than in other parts of the country.  In addition, there had been extensive fraud and abuse prosecutions of HHAs in Miami.  Similar types of patterns were observed in areas where new moratoria were applied in the February 4, 2014 Notice.

CMS was granted these authorities as way to reduce fraud and abuse in the Medicare program in areas of the country where there has been a high incidence of fraud and abuse.  In each instance CMS consulted with state Medicaid authorities to ensure that beneficiaries in areas where moratoria were applied would not be jeopardized.