CMS failed to report disciplined providers

Databases are only as good as the data within. Unfortunately, a national database of Medicare providers has more holes than expected, thanks to Centers for Medicare & Medicaid Services failure to keep parts of it updated.
Although CMS took disciplinary actions against providers, it did not report all of those actions to the national Healthcare Integrity and Protection Data Bank (HIPDB) as required by law, according to a report recently released by the Office of the Inspector General. This revelation comes in a year when media investigations revealed that many states were failing to report disciplinary actions taken against health practitioners to a national database.

The HIPDB database is designed to help hospitals and other entities make informed hiring decisions. It is supposed to prevent incompetent, fraudulent, or abusive medical providers from crossing state lines to practice and put patients at risk.

CMS officials thought that only adverse actions related to fraud and abuse had to be reported to the database. In fact, CMS is required by law to report more types of disciplinary actions to the database. They include revocations and suspensions of laboratory certifications; provider terminations from participating in Medicare; civil monetary penalties against all types of providers, managed care plans and prescription drug plans.

Among the OIG findings:

  • One division of CMS that is responsible for tracking and reporting actions against Medicare-certified providers didn't report any actions between 2001 and 2008. In contrast, 20 reports of adverse actions against providers such as labs, clinics and medical doctors, were reported to the HIPDB in 2000. As it turns out, the CMS division was not reporting terminations if appeals were pending, although they should be reported to the database regardless, according to the OIG.
  • None of the 148 adverse actions imposed on labs in 2007 and the 30 adverse actions imposed on managed care and prescription drug plans between Jan. 1, 2006, and July 31, 2009, had been reported to the data bank at the time of the OIG review.
  • CMS failed to report 45 nursing homes, which it had banned from 2004 to 2008 from getting Medicare dollars, until the fall of 2009.

In a written response to the OIG report, CMS described plans to report adverse actions imposed against nursing facilities, laboratories and durable medical equipment suppliers.

To learn more:
- read the report from the Office of the Inspector General
- see the ProPublica article

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