A report from the Department of Health and Human Services Office of the Inspector General (OIG) shows that although the Centers for Medicare & Medicaid Services (CMS) took adverse actions against providers, it failed to report all of these actions to the Healthcare Integrity and Protection Data Bank (HIPDB).
The HIPDB is a repository of "all final adverse actions against health care practitioners, providers, and suppliers." The purpose of the HIPDB is to provide states, federal agencies, and health plans with a resource to help them prevent dealings with practitioners, providers, and suppliers with a history of fraud and abuse.
The report, titled "CMS Reporting to the Healthcare Integrity and Protection Data Bank," revealed that CMS failed to properly report actions taken against laboratories, DME suppliers, and nursing homes. These adverse actions either went unreported even when final action was taken, or were reported outside of the required reporting timeframe, which is about 30 days from the date action was taken, or the date that the reporting entity discovered the action.
The OIG recommended that CMS resolve the problem by providing staff and contractors with better education on reporting requirements. CMS agreed with the findings and pledged to work with the Health Resources and Services Administration (HRSA) to determine what actions are reportable.
This report reminds us that MSPs must be diligent when performing credentialing functions. The data we rely upon is only as good as the reporting source. You cannot evaluate data pulled from one source with a "vacuum mindset." When pulling reports, compare the information you collect along with other reports as well as the provider's history. This investigative step may help you to disclose adverse actions that may not be found in database reports.
To read the full OIG report, click here:
Source: Department of Health and Human Services, Office of the Inspector General