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TO: All
Medicaid Providers
RE: Fingerprint-Based
Criminal Background Checks (FCBC) on Providers
As a reminder, federal regulations require states to conduct a
fingerprint-based criminal background check on providers or any person with five
percent or more direct or indirect ownership interest in the provider who meets
any of the criteria below pursuant to 42 C.F.R. § 455.450:
1. Providers whose screening
categorical risk level is set at “high.”
2. Providers
whose screening categorical risk level has been adjusted to “high” due to a
payment suspension based on a credible allegation of fraud, waste, or abuse.
3. Providers
whose screening categorical risk level has been adjusted to “high” because they
have an existing Medicaid overpayment.
4. Providers
who have been excluded by the Office of Inspector General or another state’s Medicaid
program within the previous 10 years.
5. Providers
who were prevented from enrolling during a state or federal moratorium and apply for enrollment as a provider at any
time within six months from the date the moratorium was lifted.
FCBCs will be conducted at the following times:
1.
Initial enrollment
- All providers designated as a “high” categorical risk will be screened for an
FCBC. If an FCBC has already been conducted by Medicare, the Alabama Medicaid
Agency (Medicaid) may be able to rely on Medicare’s information.
2. Currently-enrolled
providers – These providers will be requested to complete an FCBC at the time their risk level is elevated to “high.”
3. Application
for enrollment by previously-sanctioned providers–After a provider’s sanction
has been lifted, they will be required to complete an FCBC again before enrolling
in the Alabama Medicaid program.
Providers who are required to submit an FCBC will be notified individually
by letter requesting them to visit the Alabama Law Enforcement Agency or their
nearest law enforcement agency within 30 days from the date of their
notification letter to submit their fingerprints for processing. Medicaid will
supply the provider with all necessary documentation to complete the
fingerprint process.
Any provider who is required to submit to an FCBC and does not comply
with Medicaid’s request to complete the process will either be denied
enrollment, or their Medicaid participation will be terminated. Additionally,
the results of a provider’s FCBC may impact the provider’s participation in the
Medicaid program.
If you have any questions, please contact Medicaid Provider Enrollment at
(334) 353-5949.
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