Those who own 5 percent or more in a physician practice may be considered high risk, and  be required to complete a fingerprint-based background check. Medicare Administrative Contractors began requesting these background checks due to screening provisions in a 2014 regulation under the Affordable Care Act.

CMS automatically deems high risk those who are newly enrolled as durable medical equipment providers. Individuals and providers also qualify as high risk if: 

• CMS has suspended your payments within the past 10 years;
• The Office of the Inspector General excluded you from Medicare;
• CMS revoked your billing privileges within the past 10 years;
• You’re excluded from any federal health care program;
• You received a final adverse action within the past 10 years; or
• Medicaid terminated or otherwise precluded you from billing.

Requests come via mailed letters and you have 30 days from the date of the request to comply. Submit fingerprints electronically or via the FD-258 form. Learn more in this MLN Matters article [PDF].