Enhanced Enrollment Screening of Medicare Providers: Early Implementation Results

To bill for services they provide to beneficiaries, providers must enroll in Medicare and periodically revalidate this enrollment. Effective enrollment screening is an important tool in preventing Medicare fraud. The Centers for Medicare & Medicaid Services (CMS) has sought to enhance the enrollment screening process with new antifraud tools such as placing providers in risk categories, increasing site visits, requiring fingerprinting, implementing an Automated Provider Screening system, and denying enrollment to providers whose owners have unresolved overpayments. This study examines CMS's early implementation of new screening tools intended to prevent illegitimate providers from enrolling in Medicare.