OIG Report Shows CMS' Failure to Report Adverse Actions to HIPDB

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:
http://www.oig.hhs.gov/oei/reports/oei-07-09-00290.pdf


Source: Department of Health and Human Services, Office of the Inspector General

Cynthia Grubbs, JD, RN Named New DPDB Director

Cynthia Grubbs, R.N., J.D. has been appointed the Director of the Division of Practitioner Data Banks (DPDB). Prior to accepting this position, Ms. Grubbs was Deputy Program Manager and Senior Policy Analyst for SRA International. She was the lead policy expert for SRA’s National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank project team. Ms. Grubbs has also held several prior roles with the NPDB and the Health Resources and Services Administration (HRSA).

In addition to her work with SRA and HRSA, Ms. Grubbs has worked as a staff attorney practicing in the medical malpractice and personal injury fields and has over 8 years of experience as a Registered Nurse.

Ms. Grubbs replaces Acting Director Mark Pincus, who will remain with HRSA.

Ms. Grubbs has been valuable in providing education to NAMSS' members on the NPDB. She presented a webinar on the NPDB's Section 1921 changes this past winter, and is scheduled to present at the NAMSS Annual Conference in October. NAMSS would like to congratulate Ms. Grubbs on her recent appointment.


Source: Health Resources and Services Administration (HRSA)