CMS Not Reporting Actions Against Providers
Agency’s internal halt to reporting to HIPDB undercuts intra-agency efforts to fight Medicare fraud.
- By David Kopf
- Sep 23, 2010
While HHS has made announcements this week regarding new anti-fraud tools, it turns out that CMS has, as a matter of internal policy, stopped reporting to a database used by various agencies the actions it has taken against fraud perpetrators.
In a new report, “CMS Reporting to the Healthcare Integrity and Protection Data Bank,” from the Office of Inspector General for the Department of Health and Human Services, starting in 2008 CMS stopped reporting adverse actions against durable medical equipment to the HIPDB.
The HIPDB, which is managed by the Health Resources and Services Administration, is a national database that contains reports of adverse actions against health care practitioners, providers, and suppliers that have engaged in some kind of fraud. The actions can include licensure and certification actions, exclusions from participation in Federal and State health care programs, criminal convictions, civil judgments related to health care, and any other adjudicated actions or decisions that the Secretary of Health & Human Services establishes by regulation.
The purpose of collecting the data is to provide a pool of information that other federal agencies, as well as state agencies, access for purposes of employment, affiliation, certification, or licensure decisions.
“The HIPDB plays an important role in preventing the employment of potentially fraudulent or abusive providers, so it is important that the information it contains be complete and accurate,” the report stated.
However CMS decided to stop reporting to the system, despite a requirement to do so. The HIPDB contained 5,125 adverse actions against DME suppliers imposed from 1998 through 2008. The HIPDB contained no adverse actions against DME suppliers taken after 2008, according to the report, which noted that DME fraud is an ongoing issue, and that Medicare—Medicare paid more than $30 million in fraudulent claims to DME suppliers in 2008 alone.
The report provide a somewhat surprising reason for CMS’s decision to stop reporting to the HIPDB:
“According to the officials with whom we spoke, as a cost-saving measure, CMS is no longer reporting adverse actions taken against DME suppliers to the HIPDB,” the report stated.
In addition to not providing what would be valuable information to other agencies that could be used to fight the fraud that costs CMS tens millions of dollars annually, the lack of available information make its hard to judge the effectiveness of more recent “preventative” anti-fraud measures, such as accreditation and surety bonds. (As the old saying goes, “you can’t manage what you can’t measure.”)
“Our concern is that any numbers that get reported by any of the federal agencies ned to take into account the impact of surety bond requirement and the accreditation requirement that have been in effect for a year now,” said Michael Reinemer, vice president of Communications and Policy for the American Association for Homecare. “We have to believe that they had an impact on fraud and what we don’t want to see is the federal agencies trot out old numbers from 2006-2007.”
Actions against DME providers weren’t the only group of Medicare and Medicaid providers on which CMS stopped reporting. The report also included data regarding CMS’s non-reporting of actions taken against laboratories, managed care, prescription drug plans and nursing homes.
The HHS OIG says that CMS has concurred with its recommendation to start reporting to the HIPDB again, and described planned efforts to report adverse actions imposed against nursing facilities, laboratories, and DME suppliers.
HHS OIG also reported that CMS issued instructions to the National Supplier Clearinghouse to submit reports for suppliers whose Medicare billing privileges were revoked in 2009 and will establish procedures to ensure the contractor reports adverse actions monthly to the HIPDB.
Download the full report at http://oig.hhs.gov/oei/reports/oei-07-09-00290.pdf.
David Kopf is the Editor of HME Business.