NEMT Driver Attestation Forms in 2027: What You Sign and What Each Line Commits You To

An attestation is the shortest form you will sign as a NEMT owner, and one of the most serious. A state, health plan, or broker hands you a page of statements about your drivers and your company, and your signature tells it each one is true. It relies on that page instead of checking every item itself, so when a line is wrong, the risk lands on you.

What a NEMT driver attestation form is

A driver attestation form is a signed statement that your drivers meet a set of requirements. You will meet three kinds.

• Driver qualification attestations. These confirm that each driver meets the state’s minimum standards. North Carolina’s provider permission matrix (dated August 16, 2026) asks every NEMT van company enrolling in NCTracks for a NEMT Driver Attestation form signed by the office administrator. Indiana’s Medicaid enrollment module (version 7.1, published September 8, 2026) has taxi and common carrier providers attest, at enrollment, revalidation, and recertification, that they have a drug law process, will disclose each driver’s driving history on request, and have reported every current driver. Upper Peninsula Health Plan in Michigan has every agency and individual driver sign a NEMT attestation before serving its members.
• Broker and plan compliance attestations. These are yearly certifications about training, codes of conduct, privacy, and records. Modivcare, Alivi, and WellTrans each collect one.
• Trip attestations. On many trip logs, the driver’s signature is an attestation too. Minnesota’s statute requires the driver to sign each trip record, attesting that it shows the services given and the actual miles driven, and acknowledging that misreporting can lead to civil or criminal action. NEMT trip documentation covers those signatures.

This page covers the first two kinds. They come on top of broker credentialing, not instead of it: credentialing collects your documents, and the attestation is your signed promise that the documents stay true for every driver you use.

The four lines federal law puts on every driver attestation

Congress set the floor in 42 U.S.C. 1396a(a)(87), added by the Consolidated Appropriations Act, 2021. Each state plan must have a way, which may include an attestation, to make sure that every NEMT provider and driver it pays meets four minimums. Public transit authorities are left out.

1. Not excluded. The provider and each driver are not excluded from any federal health care program and are not on the HHS OIG exclusion list.
2. A valid license. Each driver has a valid driver’s license.
3. A drug law process. Each provider has a process to address any violation of a state drug law.
4. Driving history disclosure. Each provider has a process to disclose each driver’s driving history, including traffic violations, to the state Medicaid program.

CMS repeats the four lines in its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023). It adds that federal Medicaid law sets no other basic driver standards, so states and brokers write the rest.

Michigan shows how a state builds on the floor. Section 4 of the NEMT chapter of its Medicaid Provider Manual (version October 1, 2026) requires family members, foster parents, taxicab drivers, and rideshare companies and their drivers to be off the state’s sanctioned provider list as well as the federal exclusion list. They also cannot have a felony conviction after August 21, 1996 for making, distributing, prescribing, or dispensing a controlled substance. Upper Peninsula Health Plan applies those rules to every agency and driver and turns them into six lines. You promise that no driver is excluded or sanctioned, every driver has a valid license, no driver has that drug felony, you will report any drug felony, and you will disclose driving history. The sixth line rules out any driver with more than two moving violations, an operating while intoxicated conviction, or a DUI in the past two years.

What broker and plan attestations ask you to certify

Broker attestations reach past the four federal lines into training, conduct, and record keeping.

Modivcare

Modivcare’s Transportation Provider Compliance Attestation (the 2025 version posted as of October 2026) has an authorized representative certify, for the company, that:

• All owners and drivers serving Modivcare completed its code of conduct and its compliance training (Medicare and Medicaid general compliance and fraud, waste, and abuse, HIPAA privacy and security, the ADA, health, safety, and welfare, and cultural competency), or substantially similar training. North Carolina providers add a course on passengers who have experienced trauma.
• The company follows all laws for NEMT, including driver and vehicle credentialing rules.
• The company keeps records showing the training was completed for the calendar year, keeps them at least 10 years, and hands them over free on request.
• New employees serving Modivcare finish the training within 30 days of hire.
• The company tells Modivcare immediately of any accident, incident, or moving violation involving its drivers or vehicles, and drivers keep Modivcare’s accident form in the vehicle.
• The company has a conflict of interest policy or follows the one in Modivcare’s code of conduct.
• The company does no offshore work with protected health information.

The last line lets Modivcare give your signed attestation to its state agency and health plan clients to show compliance. A training roster comes with it, where each employee signs next to the courses and the completion date.

Alivi, WellTrans, and Tennessee plans

• Alivi. Its Downstream Provider Oversight Policy (effective January 1, 2025) requires a signed provider attestation before you start and every year after. It lists 13 areas, including the code of conduct, OIG and SAM screening, HIPAA, record retention, background screening, and ownership disclosure. Alivi audits at least 5 percent of its active downstream providers each year against their attestations.
• WellTrans. Each employee signs its Acknowledgment of Required Training Attestation (2022 form) for fraud, waste, and abuse, HIPAA privacy, general compliance, and the code of conduct. Its Indiana provider agreement (revised October 16, 2025) has you warrant that every employee, including drivers and attendants, gets that training at hire and every year.
• Verida in Tennessee. The NEMT attachment to the BlueCare Tennessee Provider Administration Manual (October 1, 2026 edition) has each NEMT provider attest in writing, before its agreement with Verida and every six months after, that it will not knowingly use the services of an illegal immigrant, in the manual’s words, or a subcontractor that does. The manual makes this rule, from Tennessee’s Public Chapter 878 of 2006, a material term of the provider agreement, so breaking it can bring penalties up to ending the agreement.

When each attestation is due

State attestations come due when you enroll or revalidate. Broker attestations come at the start and then every year, except Tennessee’s, which comes every six months. Put each one on its own reminder.

Attestation	Who signs	When it is due
North Carolina NEMT Driver Attestation	Your office administrator	With your NCTracks enrollment
Indiana driver attestations	The enrolling provider	At enrollment, revalidation, and recertification
Upper Peninsula Health Plan NEMT Attestation	You or your agency’s representative	When you agree to serve its members
Modivcare compliance attestation	An authorized representative, plus a roster each driver signs	On contracting and every year, within 90 days of the request
Alivi provider attestation	Each downstream provider	Before you start and every year
WellTrans training acknowledgment	Each employee	At hire, with training every year
Verida Tennessee immigration attestation	Each NEMT provider	Before the agreement and every six months

Modivcare’s page (updated June 10, 2026) also asks owners and drivers to review the training within 30 days of the request, and says the attestation must be signed by someone with authority to attest that it is accurate and complete.

Why every line is a legal promise

Brokers collect attestations because federal managed care rules hold the plans they work for to account. A plan may not employ or contract with excluded providers (42 CFR 438.214). The plan, and any subcontractor it delegates coverage of services and payment of claims to, must run a compliance program that includes training for employees (42 CFR 438.608). Each subcontractor must let the state, CMS, and HHS OIG audit its records and those of its own contractors, such as you, through 10 years after the contract ends or an audit closes, whichever is later (42 CFR 438.230). Your signature is how the broker shows its regulators that you meet those rules.

That is also why a false line carries weight.

• The False Claims Act. Anyone who knowingly makes a false record or statement material to a false claim is liable under 31 U.S.C. 3729(a)(1)(B). Knowingly includes deliberate ignorance and reckless disregard, with no proof of intent to defraud. A claim includes a request to a contractor, such as a broker, when federal money pays any part of it. Liability is three times the government’s loss plus a penalty of $14,308 to $28,619 per claim, for penalties assessed after July 3, 2025 (28 CFR 85.5). The False Claims Act glossary entry explains how a mistake differs from a false claim.
• Civil money penalties. Under 42 U.S.C. 1320a-7a(a)(9), a knowingly false statement, omission, or misrepresentation of a material fact in an application, bid, or contract to join a federal health program, including a Medicaid health plan’s network, can bring a penalty for each false statement. HHS’s table set the maximum at $127,973 when it was adjusted on January 28, 2026 (45 CFR 102.3). Contracting with someone you knew or should have known was excluded carries up to $25,595 for each item or service.
• Exclusion. OIG may exclude anyone who commits an act covered by those penalty rules (42 U.S.C. 1320a-7(b)(7)). An excluded company can receive no federal health program payment for anything it furnishes.
• The contract. A broker that finds a false attestation can stop sending trips and end your agreement, separate from anything the government does. WellTrans’s Indiana agreement, for example, makes its training promise a material warranty, allows termination on 30 days’ notice for a material breach left uncured for 10 days, and allows immediate termination on reasonable evidence of fraud.

The practical risk is quiet. If you sign that every driver finished fraud and HIPAA training and two did not, every trip those two drove sits on top of a false statement.

The record behind each line

Before you sign, match each line to a record you could hand over the same day. This grid pairs the common lines with the proof that backs them.

The line you sign	The record that proves it
No owner, manager, or driver is excluded	A dated result for each person from the OIG list, SAM.gov, and your state’s list, every month
Every driver has a valid license	A copy of each license with its expiration date
You have a drug law process	Your written drug and alcohol policy and each driver’s test results
You disclose driving history	Each driver’s driving record and proof you sent it where asked
Training is done for the calendar year	A roster with each name, course, completion date, and signature, or certificates
New hires trained within 30 days	Each hire date next to the training completion date
Accidents and violations reported right away	Each incident report and the date you notified the broker
No offshore work with rider information	A list of each vendor that touches rider data and where it works

OIG’s Special Advisory Bulletin on the effect of exclusion (May 8, 2013) says to check its list before you hire and periodically after, and that monthly checks best limit your risk because OIG updates the list monthly. It advises keeping proof of the first search, such as a printed screenshot of the results, and of any later search you run to check a possible match. It also says excluded people may not provide transportation paid by a federal health program. Log each search on the exclusion screening log and each course on the driver training log. For the checks behind the license and driving record lines, see NEMT driver background checks.

Keep these records at least 10 years. Modivcare’s attestation asks for training records that long, and the federal audit right over plan subcontractors runs 10 years. NEMT record retention sets out the rest of the schedule.

How to sign an attestation without guessing

1. Read every line, including the small words. “All owners and drivers” includes you if you drive. “Or substantially similar” means your own training must cover the same topics.
2. Pull the record for each line and each person. Check every driver on your roster, not only the ones who drive that broker’s trips most.
3. Fix gaps before you sign. Finish the missing course, run the missing search, or take the driver off that broker’s trips until it is done.
4. Have the right person sign. North Carolina names the office administrator. Modivcare wants someone with authority to vouch that the form is accurate and complete.
5. File the signed copy with its proof. Keep the form, the roster, and the search results together for each year.
6. Set the next due date. Add it to your compliance calendar, with a reminder 30 days ahead.
7. Report changes as they happen. Upper Peninsula Health Plan’s form says to call 1-906-225-7085 immediately when you must make a report. Modivcare wants immediate notice of accidents, incidents, and moving violations.

If a line stops being true after you sign

Things change between signatures. A driver gets a DUI, a training lapses, or a monthly search turns up a match. Act the same week.

• Take the driver off trips until the problem is fixed or the driver is cleared.
• Tell the broker in writing, using the reporting line its form or contract names.
• If someone is excluded, stop billing for their work. If you report it through OIG’s Self-Disclosure Protocol (November 8, 2021), you must first screen all current employees and contractors, then report every excluded person in one submission.
• Return money paid for trips you cannot stand behind. The 60-day overpayment rule explains the deadline and where the refund goes.

Speed matters under the False Claims Act too. A court may cut damages from triple to double when the company gave the government everything it knew within 30 days of learning it and cooperated fully, as long as no action had begun and it did not know of an investigation (31 U.S.C. 3729(a)(2)). For the yearly calendar that keeps each line true, see NEMT recredentialing.