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Massachusetts Healthcare Background Check

The Section 6401 provision of the Affordable Care Act requires a fingerprint-based criminal background check as part of the new enrollment and screening requirements applicable to all "high" risks providers and any person with a minimum of 5% in ownership or direct involvement in such companies. The final rule under Section 6401 established the risk levels to types of providers which Medicare recognizes. MassHealth has adopted these risk levels and also assigned risk levels to Medicaid-only providers. The risk levels determine the requirements for enrollment and screening of providers for the particular type of provider or service. In some circumstances, MassHealth may rely on background checks and fingerprinting performed by Medicare.

This is a listing of provider types that have been identified as being high-risk.

High-Risk Providers

Adult Foster Care Providers

Group Adult Foster Care Provider

New enrollees in the following provider types:

  • DME Providers Personal Emergency Response System (PERS) Providers (newly inscribing after August 1 onwards, 2015 only)
  • Home Health Agencies (newly enrolling from or after August 1 in 2015 only)
  • Orthotics Providers (newly joining on or after August 1 for 2015 only)
  • Oxygen and respiratory therapy equipment providers (newly enrolling after August 1, 2015 only)
  • Prosthetics Providers (newly inscribing as of August 1 in, 2015 only)

 Federal regulations also require that any provider that meets one of the following criteria be classified as high risk:

  • Have had a suspension of payments based on a credible accusation of waste, fraud, or abuse since 8/1/15.
  • Not covered by OIG or a different state Medicaid program in the last 10 years;
  • A qualified overpayment is registered or revalidated or on or after August 1, 2015, or
  • In a type of provider that was before subject to an enrollment moratorium that now is subject to an enrollment moratorium, it

To sign up to enroll following the lifting of the moratorium.

Processing and Notification

Providers will receive a written notice by MassHealth that they or their owners must undergo fingerprinting through the Statewide Fingerprint Identification Services (SAFIS) to conduct a fingerprint-based search of the national and state criminal histories. Everyone must set up an appointment and get their fingerprints taken within 30 days of receiving the notification. The providers must ensure that all of their owners with a valid identity are scheduled for an appointment within the time frame. Learn more about the Massachusetts healthcare background check




All Provider Bulletin 267 April 2017


The notification letter will contain instructions on setting up an appointment. In addition, appointments can be scheduled by visiting the MorphoTrust USA IdentoGo(r) website at: http://www.identogo.com/FP/Massachusetts.aspx. The site provides information on fingerprint services, places of operation, hours of operation, and acceptable identification methods. Individuals can also make an appointment by calling (866) 349-8130.

The appointment will be scheduled after the person receives an ID number for registration from MorphoTrust. The individual must bring the ID number with them to the appointment. Failure to scan the fingerprints of all individuals on the notice letter checked within thirty (30) days could result in the denial of an enrollment request or the termination of your enrollment process with MassHealth. If, in addition, providers and their respective owners were discovered to have an insufficient criminal record and criminal history, the MassHealth agency can deny their enrollment or end or end their MassHealth enrollment. To avoid termination or denial, providers could be required to remove owners who do not have their fingerprints examined within 30 days or find themselves with an unsuitable criminal record for authorities at the MassHealth agency.

Massachusetts Healthcare Background Check Results

Any criminal history that the MassHealth agency finds inappropriate will be made available to each provider individually or owner of the property with a criminal record. Owners and providers with unsatisfactory criminal records will be given the opportunity to rectify any errors within their files. If they schedule an appointment, the client will be required to mark an option to confirm that they've been advised of the procedure to contest the accuracy or fullness of the criminal history records as laid out within Title 28 CFR 16.34. Copies of these procedures can be downloaded from https://www.fbi.gov/file-repository/challenge- brochure.pdf/view and the DCJIS website at http://www.mass.gov/cjis/.


If you have any questions about the information in this bulletin or obtaining your criminal history record results, please contact the MassHealth Customer Service Center at 1-800-841-2900 and e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974.

Updated on 2022-11-04 19:33:49 by larry coleman

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