KY Medicaid providers considered high risk according to the provisions of 42 CFR 455.434 are required to undergo with a fingerprint-based criminal background check (FCBC).
High risk can apply to individual or organizational providers and is defined by two federal regulations, 42 CFR 424.518(c) and 455.450(e). Providers in this category include
- Home health agencies;
- Durable medical equipment suppliers;
- Providers excluded by HHS/OIG or another state Medicaid program in the previous 10 years;
- Providers on a payment suspension in the previous 10 years; and/or
- Providers that upon enrollment or revalidation are found to have an outstanding overpayment of $1500 or more owed to DMS. This does not apply to providers with an overpayment under appeal, in a payment plan or on hold.
Further, a person with five percent or more direct or indirect ownership in a high-risk provider are required to undergo a national FCBC.
Please contact Provider Enrollment at (877) 838-5085 if you have any questions.