Criminal History Requirements
Criminal history checks are required for both enrolling and re-enrolling Medicaid providers. The following individuals in each provider organization are required to have criminal history checks:
All partners or shareholders with an ownership interest of five percent or more;
All officers (this includes the president, vice president, etc.);
All directors (this is the board of directors);
Financial records custodian;
All billing agents;
All managing employees or affiliated persons, including pharmacy managers;
All individuals authorized to sign on the account used for electronic funds transfer.
If individuals belong to more than one of the above categories, they only require one criminal history check.
Fingerprint Cards Requirements
The criminal history check is conducted based on the applicants’ fingerprints. Applicants are required to submit a copy of their fingerprints on the fingerprint card included in the Florida Medicaid Provider Enrollment Application package.Providers may not use other types of fingerprint cards. Additional cards can be obtained from the fiscal agent or any area Medicaid office.
Payment for Criminal History Check
Provider applicants are required to submit a check made payable to the Agency for Health Care Administration for each fingerprint card submitted with the Enrollment Application.
Criminal History Check Process
The fiscal agent submits the fingerprint cards to FDLE. FDLE conducts a state criminal-background investigation that is called a Level 1 check. FDLE forwards the fingerprints to the FBI for a national criminal-history record check. This is called a Level 2 check.
Rejected Fingerprint Cards
Applicant fingerprint cards that are rejected by the FBI will be returned directly to Medicaid Contract Management. Rejected fingerprint cards will be accompanied by a United States Department of Justice Form 1-17 A, Rev 5-2-96, or Form 1-12, Rev 4-28-97, that lists the various reasons a fingerprint card may be rejected. If a fingerprint card is rejected, it will be necessary for the applicant to submit a new fingerprint card.
In order to preclude duplicate payments and to receive a complete FBI record, the applicant must submit the rejected fingerprint card along with a new fingerprint card to Medicaid. If the second card is rejected and returned by the FBI, additional payment will be required before a third submission. Failure to successfully submit a new fingerprint card may result in denial of a pending enrollment or termination of an active provider.
Exemption For Board Members
Board members of a not-for-profit corporation or organization are exempt from the criminal history check if they meet all of the following criteria:
Serve solely in a voluntary capacity; Do not regularly take part in the day-to-day operational decisions of the corporation or organization; Receive no remuneration from the corporation or organization for their service on the board of directors; Have no financial interest in the corporation or organization; and Have no family members with financial interest in the corporation or organization.
To obtain the exemption, the corporation or organization must submit a NonProfit Organization Volunteer Board Member Affidavit for Exemption from Medicaid Criminal History Checks along with a list of the board members’ names and social security numbers. The Non-Profit Organization Volunteer Board Member Affidavit for Exemption from Medicaid Criminal History Checks is an attachment to the Florida Medicaid Provider Enrollment Application, AHCA Form 2200-0003, F.A.C.
Note: A Non-Profit Organization Volunteer Board Member Affidavit for Exemption from Medicaid Criminal History Checks may be obtained from the Medicaid fiscal agent by calling Provider Enrollment at 800-289-7799 and selecting Option 4 or by downloading the form from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and then on Enrollment.
Exemption for Providers
The following providers are exempt from the criminal history check:
Hospitals licensed under Chapter 395, Florida Statutes. (This exemption does not apply to the physicians’ groups, laboratories, pharmacies, or other non-institutional providers that are not licensed under Chapter 395, but are owned by or affiliated with the hospital.)
Nursing facilities, hospices, assisted living facilities, and adult family care homes licensed under Chapter 400, Florida Statutes. (This exemption does not apply to the physicians’ groups, laboratories, pharmacies, durable medical equipment companies or other non-institutional providers not licensed under Chapter 400, but are owned by or affiliated with the nursing facilities, hospices and assisted living facilities.)
Units of local government. (This exemption does not apply to nongovernmental providers and entities that contract with the local government to provide Medicaid services. The contracted entities are responsible for the cost of the criminal history checks for all applicable staff and management.)
Any business that derives more than 50 percent of its revenue from the sale of goods to the final consumer AND either the business or its
controlling parent is required to file a form 10-K or similar statement with the Securities and Exchange Commission OR the business has a net
worth of $50 million or more. (This exception is designed primarily to exclude large pharmaceutical companies. The business must submit its
annual report including audited financial statements or 10-K Form with the exemption request.)
To obtain the exemption, the provider must submit an FDLE Criminal History Check and Fingerprinting Exemption Request. The FDLE Criminal History Check and Fingerprinting Exemption Request is an attachment to the Florida Medicaid Provider Enrollment Application, AHCA Form 2200-0003, which is incorporated by reference in 59G-5.010, F.A.C.
Note: An Exemption Request form may be obtained from the Medicaid fiscal agent by calling Provider Enrollment at 800-289-7799 and selecting Option 4 or by downloading the form from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and then on Enrollment.
Exemption for Government Entities with Previous Criminal History Checks
If a government agency or government-owned facility already obtains criminal history checks on its employees, Medicaid does not require another check if the following criteria are met:
The government agency or government-owned facility submits documentation in the form of a letter or official form from the screening agency, which specifies the applicant’s name and dates of the FDLE and FBI criminal history checks;
The previously completed criminal history check is no more than 12 months old as of the date of receipt of the application; and Medicaid reserves the right, on a case-by-case basis, to reject any criminal history check deemed questionable, or to require that a new criminal history check be completed and the appropriate fee submitted to cover payment required by FDLE.
Criminal history check exemption policies for government agencies apply to hospital taxing districts, such as the North Broward Hospital District; state agencies, such as county health departments; and state university system facilities, such as the University of Florida, Shands Teaching Hospital.
Exemption for DCF License
Criminal history checks are not required for medical foster care or private transportation providers who have a Florida Department of Children and Families license.
Exemption for Physicians, RNs and ARNPs
Criminal history checks are not required for physicians, podiatrists, chiropractors, registered nurses, and advanced registered nurse practitioners who are currently licensed through the Florida Department of Health (DOH). If an Alabama or Georgia provider is designated as an in-state provider and has a current Florida DOH license, then a criminal history check is not required. However, if the provider does not have a valid Florida DOH license; then a fingerprint card and a criminal history check is required.
Criminal History Check by Other Agencies
Medicaid accepts criminal history checks conducted by other Florida agencies or departments that have been completed within 12 months of receipt of the application. The provider must submit a letter or official form from the agency that conducted the criminal history check with the Enrollment Application. The letter or form must specify the applicant’s name, Social Security Number, date the criminal history check was completed, the level of the screening and the results. Medicaid Provider Enrollment will review the information and approve or deny
At this time Florida Medicaid Provider Enrollment is managed by third party vendor -HP. The submission of fingerprints for Medicaid Provider Services Level 2 Background Check is allowed by two methods. IDENTICO LLC– is FDLE approved live scan vendor provides physicians’ groups, laboratories, pharmacies and other non-institutional providers that are not licensed under Chapter 395, but are owned by or affiliated with the hospital, with solutions to comply with fingerprinting and background screening requirements of Medicaid Enrollment.
a) We can collect and submit fingerprints electronically on our Live Scan Equipment, at your location or ours. This way fingerprint cards are not required, we provide all necessary prove of individuals transaction records, including the TCN numbers. The cost of such screening is $54.25/person, you don’t have to send $43.25 check to AHCA, and this fee is included in our rate. Traveling fees may apply for mobile fingerprinting appointments.
b) We can capture fingerprints old fashion way on hard-copy fingerprint card. The client has to provide us specifically pre-printed cards made exclusively for Medicaid Provider Services. Such fingerprint cards can be requested from Medicaid Enrollment. The fee is $15/card, you would have to attach $43.25 fee payable to AHCA along with your enrollment application and the card. Traveling fees may apply for mobile fingerprinting appointments. Hard copy method is recommended for individuals with poor quality fingerprints, such prints have a high change to be denied by FBI as illegible.
Please contact us for more information. Visit our official website www.myidentico.com or call us today (954) 239-8590. We have an open door policy at our office located at 3948 Pembroke Road, Suite E, Pembroke Park, FL, 33021, however if you would like to schedule an appointment at certain time, please visit http://www.myidentico.com/hitappoint/ and we’ll serve you first regardless of any wait line.
Mobile unit appointments need to be scheduled by phone only .