Medicaid: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure

States can prevent inappropriate payments, protect beneficiaries, and reduce time-consuming and expensive "pay and chase" activities by ensuring that providers that intend to engage in fraudulent or abusive activities are not allowed to enroll in Medicaid. For States to identify potentially fraudulent providers, as well as those that may be associated with excluded individuals or entities, providers must disclose accurate and timely information about their owners (i.e., individuals or corporations with a 5 percent or more ownership or controlling interest; agents; or managing employees). According to CMS, the highest incidence of regulatory noncompliance among State Medicaid programs is in their collection of ownership information from providers.