Data pulled from two major Medicare databases--the National Plan and Provider Enumeration System and the Provider Enrollment, Chain and Ownership System--are extremely inaccurate, according to the Department of Health and Human Services’ Office of Inspector General.
Providers wishing to enroll in Medicare first must apply to get a national provider identifier through NPPES, and then enroll through PECOS. Accurate, complete and consistent data on both system helps ensure the integrity of health programs, OIG notes in a new report, and the office has previously found ongoing problems with the Centers for Medicare and Medicaid Services’ oversight of provider data.
The new study bases its results on a very small set of data in the databases. OIG randomly selected a sample of 170 providers from 987,266 individual providers with records in both NPPES and PECOS. These providers were asked to verify such individual data as name, Social Security number, date of birth, mailing and practice addresses, and license and credential information.
“In NPPES, provider data were inaccurate in 48 percent of records, and complete for nearly all required variables but incomplete for conditionally required variables in 9 percent of records,” according to the new OIG report. “In PECOS, provider data were inaccurate in 58 percent of records and incomplete in almost 4 percent. Additionally, provider data were inconsistent between NPPES and PECOS for 97 percent of records. Addresses, which are essential for contacting providers and identifying trends in fraud, waste and abuse, were the source of most inaccuracies and inconsistencies. Finally, CMS did not verify most provider information in NPPES or PECOS.”
The HHS Office of Inspector General in the report recommends that CMS require Medicare Administrative Contractors to implement program integrity safeguards, require more verification of enumeration and enrollment data, and that CMS should detect and correct inaccurate and incomplete data for new and established records. CMS concurred with the recommendations. The report is available here.
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