The final ruling that requires background checks to be implemented for Medicaid providers considered high risk is in sight. However it is still unclear as to how the 4 year delay has come about. As part of the Affordable Care Act it was initially released in 2011.

Executives who have 5% indirect or direct ownership of medical equipment and/or healthcare agencies will be automatically considered high risk. States, for their part, will, by their own discretion rank providers. If a provider has billing privileges revoked in the past ten years then CMS will further change that provider’s ranking to ‘high risk’. As from August 1st those providers deemed as high risk (Medicaid Fraud) must submit to finger printing and criminal background checks.

All state CHIP and Medicaid providers have till March of 2016 to rank all providers as high, moderate or limited risk for fraudulent use of the program further to background checks. These rankings to be carried out every 5 years. States are further required to terminate and/or deny enrolling high risk providers who will not have a background check. (incl. Fingerprints), within a 30 day period requested by the relevant State Medicaid Agency. There will be exclusions (Medicaid Program) to those facing various felony charges including money related crimes, murder and rape as examples. Also in the past those guilty of fraud in relation to CHIP, Medicare or Medicaid.

Affordable Care Act will provide American citizens with improved health security with comprehensive reforms of health insurance. The act will expand coverage while making accountable insurance companies. Health care costs will be lowered along with more choices and overall care will be enhanced for all Americans.

The Affordable Care Act is an amalgamation of 2 legislates. The Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) and The Patient Protection and Affordable Care Act (P.L. 111-148). For further reference and reading: Medicaid to subject providers to criminal background checks from August 1st

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