PDF Version

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.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2024 American Medical Association
and © 2024 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.