BISMARCK, N.D. – Gov. Kelly Armstrong today announced that North Dakota Health and Human Services (HHS) has launched a new strategy to strengthen oversight, prevent fraud and ensure the integrity of the North Dakota Medicaid program.
The strategy aligns with an April 23 letter from the U.S. Centers for Medicare and Medicaid Services (CMS) that directed states and territories to accelerate provider revalidation activities and develop a comprehensive, long-term strategy to ensure only qualified and legitimate providers participate in North Dakota Medicaid.
“Many of North Dakota’s seniors, children, and people with disabilities rely on Medicaid, and the vast majority of providers operate in good faith. Expanding oversight and prioritizing revalidation of high-risk providers will increase accountability and transparency, strengthening the program for recipients, health care providers and taxpayers,” Armstrong said. “North Dakota is proud to work with Administrator Oz, Secretary Kennedy and President Trump to improve Medicaid program integrity.”
Beginning July 1, North Dakota will expand oversight of three high-risk categories: qualified service providers, non-emergency medical transportation providers and 1915(i) providers. This will include more frequent revalidations, enhanced enrollment requirements, increased competency assessments and site visits, and a provider enrollment moratorium for certain areas.
These categories were selected because they are more vulnerable to fraudulent activity. Providers in these categories often work as independent contractors, have limited outside credentialing requirements, deliver services in home and community-based settings, and have not consistently used National Provider Identifiers, which are required to bill Medicaid for providing services.
“Our Medicaid team has already put in place many strategies to safeguard against fraud, waste and abuse. We are standing up an Office of Program Integrity, in addition to an Office of Performance Metrics. The enhanced efforts of this revalidation strategy align well with and strengthen our ongoing program integrity efforts,” said HHS Commissioner Pat Traynor. “We take our responsibility to protect the Medicaid program seriously while ensuring qualified providers continue serving North Dakotans who rely on these services.”
The two-year HHS strategy does not include revalidation of Medicare-enrolled providers because the state follows and relies on Medicare’s existing federal screening and revalidation process that ensures health care providers meet program requirements.
For more information about the two-year revalidation strategy, visit hhs.nd.gov/healthcare/medicaid/publications.
To report suspected Medicaid fraud, call 800-755-2604 and select option 3, or email medicaidfraud@nd.gov.