Home Health & Hospice

OIG Report Finds Inaccurate Data in PECOS Database

Homecare Insider, June 24, 2013

The Office of the Inspector General (OIG) released a report on May 28 that found that improvements are needed to ensure that provider enumeration and Medicare enrollment data is accurate, complete, and consistent.

Healthcare provider information, including providers' unique National Provider Identifiers (NPIs), is maintained in the National Plan and Provider Enumeration System (NPPES). To enroll in Medicare, providers must supply their NPIs and other information to the Centers for Medicare and Medicaid Services (CMS) to be entered into the Provider Enrollment, Chain and Ownership System (PECOS).

Previous OIG work has revealed ongoing problems with CMS's oversight of provider data, sometimes resulting in improper Medicare payments to fraudulently enrolled providers.

This report reveals that Medicare provider data in NPPES and PECOS was often inaccurate and occasionally incomplete and was generally inconsistent between the two databases. In NPPES, provider data was inaccurate in 48 percent of records and complete for nearly all required variables, but was incomplete for conditionally required variables in 9 percent of records. In PECOS, provider data was inaccurate in 58 percent of records and incomplete in almost 4 percent.

Additionally, provider data was 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 OIG is recommending that CMS should:

  • Require Medicare Administrative Contractors to implement program integrity safeguards for Medicare provider enrollment as established in the Program Integrity Manual
  • Require more verification of NPPES enumeration and PECOS enrollment data
  • Detect and correct inaccurate and incomplete provider enumeration and enrollment data for new and established records

Read the full OIG report today.

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