This notice serves as a reminder and education to all HCBS Consumer Directed Services (CDS) vendors regarding requirements for maintaining accurate tax identification information records in Fusion.
Per HCBS Policy 3.25 Appendix 1 and 19 CSR 15-8.400, CDS vendors are required to complete the following for all CDS consumers:
Enter both the Federal Employer Identification Number (EIN) and the Missouri Tax ID directly into the consumer’s record under the “HCBS Eligibility” section in Fusion. Upload proof of EIN to the “Documents” tab under the “EIN Tax Documents” subtype.An audit conducted on June 22, 2026, by the Division of Senior and Disability Services (DSDS) identified significant compliance gaps regarding missing or incomplete EIN and Missouri Tax ID entries in provider records. Missing entries can delay the processing of required information and may interfere with timely service delivery to consumers.
On July 10, 2026, DSDS will be contacting individual CDS vendors with detailed findings from your agency and the required remediation actions. The email will be sent to the business email address listed with MMAC. Vendors must review the consumer records and complete all required corrections no later than August 31, 2026.
Please note that any consumer records not brought into compliance by the deadline will be referred to Missouri Medicaid Audit and Compliance (MMAC) for further administrative action.
The Missouri Department of Social Services (DSS) Division of MO HealthNet (MHD) program is funded by taxpayers to provide essential medical services to eligible participants. Fraud by Medicaid providers harms taxpayers, affects participants, and undermines the work of honest providers.
The Missouri Medicaid Audit & Compliance (MMAC) team investigates Medicaid provider fraud, waste, and abuse. Missourians can play a vital role in protecting the integrity of this program.
Report Medicaid Provider FraudIf you suspect a Medicaid provider is misusing the program, please contact:
Call: (573) 751‑3285 Email: MMAC.ReportFraud@dss.mo.govExamples of provider fraud include:
Billing for services not provided Upcoding or billing for more expensive services than delivered Billing for unnecessary services Billing multiple times for the same serviceNot Sure Which Hotline to Use?
Missouri has two distinct fraud hotlines:
MMAC Fraud Hotline – Medicaid Provider Fraud Use this hotline for suspected fraud involving Medicaid providers, billing practices, or misrepresentation of services. Welfare Investigation Unit (WIU) Fraud Hotline – Public Assistance Participant Fraud Use this hotline to report concerns about individuals misrepresenting information to obtain public assistance benefits. Missouri’s Fraud Hotlines:Medicaid Provider FraudPublic Assistance Participant FraudWhen to call:Use this hotline for suspected fraud involving Medicaid providers, billing practices, or misrepresentation of services.Use this hotline to report concerns about individuals misrepresenting information to obtain public assistance benefits. Examples:• Billing for services that were never provided• Billing for more expensive services than were delivered
• Billing for unnecessary services
• Billing multiple times for the same service• Providing false income, employment, or resource information
• Misrepresenting household members or residency
• Giving false information to receive more benefits than allowedCall:(573) 751‑3285(877) 770‑8055Email:MMAC.ReportFraud@dss.mo.govDLS.ReportFraud@dss.mo.gov
The Missouri Medicaid Audit & Compliance (MMAC) Unit is issuing this notice to inform select providers of an upcoming, two-phased off-cycle provider revalidation initiative. This initiative is being undertaken in partnership with the Centers for Medicare & Medicaid Services (CMS), and in consultation with the Office of Governor Mike Kehoe and the MO HealthNet Division (MHD).
This revalidation effort follows Governor Kehoe’s recent communication with CMS regarding enhanced program integrity expectations and federal oversight activities. Governor Kehoe has conveyed Missouri’s commitment to an accelerated revalidation strategy of specific Medicaid provider types to ensure continued compliance with current federal and state screening, enrollment, and program requirements. This off cycle revalidation process is a key component of that strategy and is intended to reduce fraud and strengthen program integrity.
What This Means for Providers MMAC has initiated a two-phase revalidation cycle for selected provider types and individual providers outside of the normal revalidation cycle. Providers selected for this off cycle review will receive the standard 120-, 90-,60-, and 30-day letters via email at the address listed in their eMOMED account. It is the provider’s responsibility to ensure their eMOMED account contact information is up to date. If providers receive a revalidation letter(s) via email, they must revalidate prior to the deadline noted in the letter.Failure to complete the required revalidation steps within the designated timeframe will result in administrative action, including termination as a provider from the MO HealthNet program.
Who Needs to Revalidate Phase I: The following Provider Types shall revalidate prior to October 1, 2026: Adult Day Care providers (Provider ID beginning with “29”) Durable Medical Equipment Suppliers (Provider ID beginning with “62”) Providers without NPIs, Any other provider identified as “high-risk” by CMS or MMAC. Includes Clinics (Provider ID beginning with “50”) with an Autism Center (Specialty code of “AC”) Timeline of events for Phase I: May 4 – May 30, 2026: Public Notice and educational campaign June 1 – Sept. 1, 2026: Monthly 120, 90, 60, 30-day revalidation notices sent to providers. October 1, 2026: Initiation of Administrative Action, including termination, for non-compliant providers.Phase II: The following Provider Types shall revalidate prior to March 2, 2027: Home Health Agencies (Provider Type #s beginning with “58”) Private Duty Nursing (Provider Type #s beginning with “94”) Applied Behavioral Analysts (Provider Type #s beginning with “73”) Hospice (Provider Type #s beginning with “82”) Substance Abuse (Provider Type #s beginning with “86”) Timeline of events for Phase II: Oct. 1 – Oct. 31, 2026: Public Notice and educational campaign Nov. 1, 2026 – Feb. 1, 2027: Monthly 120, 90, 60, 30-day revalidation notices sent to providers. March 3, 2027: Initiation of Administrative Action, including termination, for non-compliant providers.
MMAC appreciates your cooperation and partnership as we implement these measures to safeguard the integrity of the MO HealthNet program and ensure continued compliance with CMS guidelines.
If you have questions regarding this notice, please contact:
Missouri Medicaid Audit & Compliance (MMAC)
Provider Revalidation Unit
mmac.revalidation@dss.mo.gov
573-751-5238
Sincerely,
Richard Ferrari
Director-MMAC
Dear Missouri Medicaid Provider,
The Missouri Medicaid Audit and Compliance Unit (MMAC) is the unit within the Department of Social Services (DSS) responsible for oversight and auditing of compliance with the Medicaid Title XIX, CHIP Title XXI, and Medicaid Waiver Programs in Missouri, which include oversight and auditing of MO HealthNet providers. This includes providers who participate in one of Missouri’s four Managed Care Organizations.
MMAC is notifying you that the Centers for Medicare & Medicaid Services (CMS), through its contractor CoventBridge (USA) Inc. (CoventBridge), may randomly select a number of providers to participate in an upcoming Medicaid integrity audit. CoventBridge, the Unified Program Integrity Contractor (UPIC) for CMS in the Midwest Region, is conducting this audit in consultation with the MO HealthNet Division (MHD) and MMAC.
As part of this process, CoventBridge may request medical records from randomly selected providers to verify claims submitted between October 1, 2023, and September 30, 2025, comply with all applicable federal and state Medicaid laws, regulations, and policies.
The requested records will be used to assess the accuracy of claims and ensure adherence to MO HealthNet policies, including those applicable to providers operating within Managed Care Organizations (MCOs).
Provider Responsibilities:1. Respond to Records Requests:
If you receive a written request from CoventBridge for medical records relating to sampled claims, you are required to respond within the timeframe specified in the request. Timely submission is essential to avoid compliance issues.
2. Legal Compliance:
Under the Deficit Reduction Act (DRA) and other applicable federal and state laws, providers are legally obligated to furnish the requested medical records. Records may be released under HIPAA for Health Oversight Activities authorized by law under 45 CFR 164.512(d). Failure to comply may result in administrative actions as outlined in 13 CSR 70-3.030.
3. Staff Awareness:
Please ensure your administrative staff is aware and understands that correspondence from CoventBridge (USA) Inc. is official and requires prompt attention.
MMAC appreciates your cooperation and your continued commitment to maintaining compliance with Medicaid program requirements.
The Missouri Division of Professional Registration, a division of the Missouri Department of Commerce and Insurance (DCI), is alerting medical providers of a drug trafficking scam targeting doctors and other individuals licensed with the Missouri Board of Registration for the Healing Arts.
The scam involves fraudulent documents claiming a provider’s license has been suspended for illegal drug trafficking and requesting payment of a government security bond via wire transfer.
The documents falsely include official-looking letterhead, seals and stamps from the U.S. Department of Justice and the Missouri Division of Professional Registration Central Investigations Unit. The documents also make fraudulent use of DCI Director Angela Nelson’s signature.
Any unexpected notice of license suspension or a request for payment should be treated as suspicious:
If there is any doubt about the legitimacy of a document or other communication, contact the board at healingarts@pr.mo.gov.
If any provider receives an unexpected communication regarding license suspension due to drug trafficking or otherwise, stop immediately.
Do not submit payment in response to any suspicious communications or requests.
Read the full article on the Missouri Department of Commerce & Insurance (DCI) website.
The first phase of the hard launch of claims validation is scheduled for April 1, 2026. At that time, claims submitted for services requiring EVV and authorized by the Department of Health and Senior Services, Division of Senior and Disability Services (DSDS) (provider types 26 and 28), with no matching visits in the EAS will be denied.
The second and third phases of the hard launch will impact claims for services requiring EVV provided by Home Health Care Service providers (provider type 58) and Department of Mental Health, Division of Developmental Disabilities (DDD) (provider type 85). The timeline for these phases will be provided at a later date.
Since soft launch on January, 7, 2026, MHD, MMAC, DHSS, and MHD have been working with providers offering training webinars, resources, and phone calls to educate providers on upcoming changes.
Additionally, MHD posted a Hot Tip on January 7, 2026 and another Hot Tip posted January 27, 2026.
Providers are encouraged to review their RA to assist in the identification of claims that would be denied following the hard launch. Additionally, 13 CSR 70-3.320 requires all providers to log into the EAS system at least weekly to ensure capture, full functionality, and accuracy of visit data.
For information regarding the EVV claims validation process, visit the EVV website at https://mydss.mo.gov/mhd/evv. For questions, contact Ask.EVV@dss.mo.gov.
Missouri Medicaid Audit and Compliance (MMAC) End of Year Report is now available. This report provides an overview of the services provided by the Missouri Medicaid Audit and Compliance Unit. This report covers program activities during the state fiscal year (July 1 through June 30). The report includes descriptions of the units within MMAC and information about upcoming initiatives, such as the new Provider Enrollment solution.
DSS has a number of other reports available on the Reports webpage. If you do not have a PDF reader installed, download Acrobat Reader.
