Reminders about Required Provider Disclosures Including Expungements and Criminal Traffic Violations

NC Medicaid providers must accurately answer all Exclusion Sanction questions on enrollment, reenrollment, reverification applications and Manage Change Requests (MCRs). This includes disclosing any past infractions involving owners, agents, managing employees or other individuals listed on the application, regardless of how long ago they occurred. This includes expunged convictions and traffic violations resulting in a criminal conviction.

Traffic violations that result in a criminal conviction, such as a misdemeanor or felony, are required to be disclosed. Providers are required to disclose expungements and submit supporting documentation stating the final disposition of the conviction when applicable. In addition, providers are responsible for supplying adequate information needed to evaluate program eligibility when background checks return matches or require clarification.

Disclosures by Currently Enrolled Providers

Current providers are also required to notify the Department of the following within 30 calendar days:

• Any adverse action taken against a required license, certification, registration, accreditation or endorsement.
• Any new criminal convictions involving the provider, owner and any individual with a managing relationship listed on the provider enrollment record.

Failure to disclose required information or provide requested documentation may result in application denial or termination of the provider record.

Please review the full bulletin here: Reminders About Required Provider Disclosures Including Expungements. Providers are also encouraged to review the full NCDHHS Provider Administrative Participation Agreement and the NCTracks Exclusion Sanction Questions FAQs webpage for additional guidance.