CMS background checks missed some criminal providers, federal audit finds

The potentially ineligible providers received $1.3 million in Medicare payments, GAO says
The potentially ineligible providers received $1.3 million in Medicare payments, GAO says

Nearly 70 providers with criminal backgrounds enrolled in Medicare prior to the program strengthening its background checks, a federal audit found.

The audit report, released Wednesday by the Government Accountability Office, follows up on their July request that the Centers for Medicare & Medicaid Services improve the procedures used to verify provider practice locations and physician licensure statuses.

The GAO's audit found that 66 providers, potentially ineligible due to criminal backgrounds, were enrolled in Medicare before CMS beefed up their background check process in 2014. Of those 66 providers, 16 received roughly $1.3 million in inappropriate payments in 2013.

The offenses committed by the providers missed by the background checks include sex-related offenses, drug-related offenses, obscene communications and income tax evasion.  All of the potentially ineligible providers will be referred to CMS for further investigation, according to the report.

The audit also delved into actions taken by CMS for 146 providers identified with criminal backgrounds between 1997 and 2015, including 77 whose provider status was revoked because of a suspended or inactive medical license, felony conviction, or Office of Inspector General exclusion. Another 35 were removed from the program due to not billing consecutively for 12 months, not responding to revalidation requests or voluntarily withdrawing.