Problems Remain for Ensuring That All High Risk Medicaid Providers Undergo Criminal Background Checks

An effective provider enrollment screening process is an important tool for preventing Medicaid fraud. It plays a vital role in identifying unscrupulous providers and preventing them from enrolling in Medicaid. The Federal Government requires States to conduct risk based screening activities as part of their processes for enrolling providers in Medicaid. OIG's evaluation of the Medicaid provider enrollment screening process in 2016 found that States were struggling to implement the required screening activities. Many States had yet to implement fingerprint based criminal background checks-a screening activity required for providers that the Federal Government deems to be at high risk for fraud, waste, and abuse. If not all high-risk providers undergo criminal background checks, the Federal and State Governments are vulnerable to unscrupulous providers intent on defrauding the Medicaid program.