CMS Urges States To Submit Medicaid Provider Revalidation Strategies And Strengthen Oversight
CMS Administrator Dr. Mehmet Oz has asked state Medicaid directors to create and submit two-year provider revalidation plans as part of a wider effort to reduce healthcare fraud.
The request asks each state to explain how it checks provider enrollment data and keeps that information accurate. This includes regular revalidation and any other steps the state uses to confirm that Medicaid providers are still eligible to take part in the program.
CMS said most Medicaid providers are honest and focused on patient care. At the same time, the agency warned that some groups are using gaps in the system to make money through fraud.
The letter also asks states to increase checks on providers that fall under the high-risk category. CMS wants these providers reviewed more often than the usual five-year minimum. The agency also wants states to focus soon on high-risk providers who have not been screened in the past 12 months.
CMS also expects states to explain how they review providers who do not have a National Provider Identifier, or NPI.
States have been asked to inform CMS within 10 days if they plan to revalidate high-risk providers. They also need to submit full two-year revalidation strategies within 30 days of receiving the letter.
The request comes as CMS increases its focus on Medicaid fraud in several states, including Minnesota, New York, California, Florida, and Maine. Home and community-based services may be one area that receives more attention under this effort.
Damon Terzaghi of the National Alliance for Care at Home said personal care and related home care services will likely be a key part of this initiative. He also noted that many states have fallen behind on provider revalidation because of heavy workloads, COVID-19 pressures, and changes in Medicaid over recent years.
When states fall behind on revalidation, it can create weak spots in program oversight. Regular provider checks help confirm that Medicaid records are accurate and that only eligible providers remain active in the program.
