NC Medicaid providers must accurately answer all Exclusion Sanction questions on enrollment, re-enrollment and re-verification applications, as well as manage change requests (MCRs).
This includes disclosing any past infraction involving owners, agents, managing employees, or other individuals listed on the application, regardless of how long ago it occurred.
Expungements
An expungement is a court-ordered process, different from a pardon, that makes information about an individual’s criminal history unavailable to the public. In an expungement, court records are destroyed. While records are generally inaccessible, some government agencies are permitted to collect information about expunged records.
- NCDHHS requires providers enrolling in NC Medicaid to disclose expungements.
- When petitions for expungement are granted, the clerk of superior court sends the petitioner a certified copy of a Final Order.
- This Final Order document should be submitted with the NC Medicaid provider enrollment application as verification of expungement.
Once the record is expunged by the court system, the Final Order is destroyed along with the case file and court clerks are no longer able to furnish copies of the Final Order. However, providers might be able to obtain a copy of a Final Order from the following:
State Bureau of Investigation
Attn: Expungement Unit
PO Box 29500
Raleigh, NC 27626
NC Administrative Office of the Courts
Court Services Division
Attn: Records Officer
PO Box 2448
Raleigh, NC 27602
Understanding Burden of Proof
If a background report returns a match (whether it is an exact match or a near match) which results in the inability to make a clear determination, the burden of proof falls on the provider to produce adequate information necessary in evaluating program eligibility, as explained in the Consent to Release Information section of the NC Medicaid provider enrollment application. The full NCDHHS Consent to Release Information order document can be found on the NCTracks Terms and Conditions page.
In signing the consent, the provider understands “the North Carolina Department of Health and Human Services (DHHS) and its representatives are responsible for the evaluation of my professional training, experience, professional conduct, and judgment.” Additionally, the provider understands and agrees he/she has: “…the burden of producing adequate information and meeting basic requirements for the proper evaluation of professional competence, character, ethics and other qualifications, and for resolving doubts about such qualifications.”
If a disclosed event has insufficient or incomplete information, NCTracks will send correspondence advising that an application is incomplete and cannot be processed until additional information is submitted by the provider. Information must be received within 30 days of the request to avoid adverse action.
Requirements for Current Providers
As defined in NC Gen Stat 108C-4, and Section 8 of the NCDHHS Provider Administrative Participation Agreement, currently enrolled providers are required to notify the Department within 30 calendar days of learning of any adverse action taken against any required license, certification, registration, accreditation or endorsement of the provider or any of its owners, agents, managing employees or other individuals active in the record.
Additionally, within 30 calendar days, providers must disclose changes to the criminal convictions of anyone listed on the provider enrollment record to comply with the Department’s review of criminal history.
Potential Adverse Actions
- Failure to disclose or provide documentation results in application denial or termination of the provider record.
- Failure by the currently enrolled providers to disclose adverse actions within 30 days as contractually required may result in termination of their NCTracks provider record.
Resources
- Please review the full bulletin here: Reminders About Required Provider Disclosures.
- Providers are encouraged to read the full NCDHHS Provider Administrative Participation Agreement to ensure complete understanding of the requirements for participation with NCDHHS programs.
- Additional information is available on the NCTracks Exclusion Sanction Questions FAQs webpage.
Contact
- NCTracks Call Center: 800-688-6696
- Provider Ombudsman: 866-304-7062