CMS fails to flag physicians from defunct medical schools

Thousands of doctors in the Centers for Medicare & Medicaid Services' (CMS) Provider Enrollment, Chain and Ownership System (PECOS) list medical degrees from universities that no longer exist, all of which went unnoticed by CMS, and often the physicians themselves, according to a joint report from Vice News/MedPage Today.

More than 6,300 providers listed 70 medical schools that are no longer operating, according to an analysis by the two news outlets. CMS paid those providers $654 million in 2013. The discrepancies were likely made in error, CMS told Vice News/MedPage Today, since physicians select their medical school from a dropdown menu where some defunct universities may appear alongside legitimate ones. For example, PECOS lists one pulmonary specialist in Chicago as a graduate of Dunham Medical College, which closed in 1913. In reality, that physician attended Duke University Medical School in Durham, North Carolina.

CMS adds that it receives its list of medical schools from the American Medical Association (AMA), but never removes universities from that list so that legitimate providers that attended recently closed medical schools are not denied enrollment. However, Vice News/MedPage Today found that all but one of the 70 defunct schools identified in their analysis closed between 1864 and 1923.

More to the point, these errors went unnoticed by CMS, which was just recently criticized by the Government Accountability Office (GAO) for failing to red flag physicians that list potentially ineligible addresses or have adverse actions taken against their state medical license.

"Obviously, the credibility of doctors' education, especially as related to medical school attendance and graduation, is an important data point and a source for 'flags' as indicators that something is not quite right," Seto Bagdoyan, director of forensic audits at the GAO told Vice News/MedPage Today.

CMS said it protects against fraud through regular screening procedures; however, the GAO has routinely identified Medicare and Medicaid as high risk for fraud, waste and abuse, and screening procedures often fail to proactively identify fraud. Last year, the CMS unveiled a new process in which physicians would be required to undergo fingerprint-background checks in an effort to catch "bad actors," along with a final rule that gave the agency greater discretion in removing fraudulent providers.

For more:
- read the Vice News/MedPage Today article