CMS Pub. 100-06, ch. 3, § 140.1

Upon receipt of a bankruptcy notice, Contractors shall do the following:

1. Upon receipt of a bankruptcy notice, Contractors shall send the bankruptcy notice to the

OPOLE IFM Bankruptcy mailbox at OPOLE_IFM_Bankruptcy@cms.hhs.gov for review and

place the provider in a bankruptcy status in the Health Integrated General Ledger Accounting

System (HIGLAS).

2. The servicing CMS Office will review the bankruptcy notice and seek legal advice, if

appropriate.

3. The CMS Office will contact the Contractor/s, via e-mail, that services the bankrupt provider/s

and provide detailed instructions on the proper handling of the provider/s in the HIGLAS and

the System for Tracking Audit & Reimbursement (STAR), if applicable.

4. The Contractor shall provide a Bankruptcy Referral Checklist for the bankrupt provider/s.

5. The Bankruptcy Referral Checklist is now divided into two (2) tiers, each designed to gather

the bankruptcy information within a reasonable timeframe.

• Tier I - Information shall be submitted to the CMS Office within ten (10) business days of

receipt of the CMS instructions regarding the bankruptcy notification. If the CPI Fraud

Check results have not been received within the ten (10) business days, the Contractor

shall submit the Tier I checklist with all required information and indicate that the CPI

Fraud Check results are pending. The Contractor shall forward the CPI Fraud Check

results to the CMS Office immediately upon receipt.

• Tier II - Information shall be submitted to the CMS Office upon request.

Exhibit 1 provides the required information to be submitted for Tier 1 and Exhibit 2 provides

examples of required information for Tier II.

Exhibit 1

Bankruptcy Referral Checklist Tier I

(Submit to the CMS Office as an Excel file, via e-mail, within ten business days from receipt of the CMS

Office’ s instructions)

Description MAC Response MAC Comments

BNK Case Number

Bankruptcy Court

Petition Date

Provider Name

Provider Number (s)

Provider Tax ID Number

Any Claims Under Appeal (Y/N)?

Any Overpayments in Appeal Status

(Y/N)?

Open Cost Reports (Y/N or

N/A)? (Part A Only)

Year & Status of Open Cost

Reports? (Part A Only)

Pending Cost Reporting Years in

Appeal? (Part A Only)

Pending Cost Report Reopening(s)

(Y/N)? (Part A Only)

Any Fraud Overpayments or

Investigations (Y/N)? 1

Date of Fraud Cases, if applicable

Evidence of a Recent or Pending

CHOW (Y/N)?

1 Fraud Check Report Request Instructions

1. The Contractor shall email its fraud check request spreadsheet along with a completed

CPI data request form (Attachment #1) to CPIFraudcheck-OFMDebt@cms.hhs.gov with the

subject line “Contractor/Jurisdiction Fraud Check Request” (example – ABC/J2 Fraud Check

Request).

2. The Contractor should expect to receive the fraud check report from CPI within one week of

sending the fraud check request to CPI. The Contractor shall use the fraud check report to

determine if the provider/supplier has an open fraud case.

The Contractor shall include a copy of CPI’s completed fraud check report for the NPIs that are included

in the Bankruptcy on the checklist spreadsheet Tier I that is sent to CMS.

*Note: The CPI Fraud check applies to bankrupt providers with NPI’s. Bankrupt providers with no

NPI’s should follow the current process of checking for fraud.

Attachment #1 – Sample Fraud Check Request Form

Exhibit 2

Bankruptcy Referral Checklist Tier II

(Submit to the CMS Office upon request, via email)

Examples:

Provider Participating in Medicaid program?

Provide copies of Demand Letters or Intent to Refer Letters

Provide copies of ERS approval or Denial Letters

Other Documents upon request such as provider agreements,

surety bond letters, expected completion of cost report

settlement, appeal outcomes, etc.

Referral Checklist Instructions for Tier I:

Category Data Element Instruction Example

Tier I Bankruptcy Case Number Prescribed format for this field

is Court Abbreviation + BNK

Case Number

TNMBKE-19-12345

Tier I Bankruptcy Court Court State and Region (if

applicable)

Tennessee Middle

Tier I Petition Date Date Petition Filed in US

Bankruptcy Court

01/01/2019

Tier I Provider Name

Tier I Provider Number (s) HIGLAS Provider or Supplier

Number

12-3456

Tier I Provider Tax ID Number 12-3456789

Tier I Any Claims Under Appeal

(Y/N)

Tier I Any Overpayments in

Appeal Status (Y/N)

If Yes, provide stage of Appeal

(Ex: Reconsideration)

Tier I Open Cost Reports (Y/N

or N/A)? (Part A Only)

If not Part A workload, list N/A

Tier I Year & Status of Open

Cost Reports? (Part A

Only)

If not Part A workload, list N/A

Tier I Cost Reporting Years in

Appeal (Part A Only)

If not Part A workload, list N/A

Tier I Pending Cost Report

Reopening(s) (Y/N)? (Part

A Only)

Tier I Any Fraud Overpayments

or Investigations (Y/N)?

CPI Fraud Check Request

Tier I Date of fraud cases, if

applicable

CPI Fraud Check Request

Tier I Evidence of a Recent or

Pending CHOW (Y/N)?

Recent = Within a year of the

Petition Date