CMS Ditches Reporting of Adverse Actions

WASHINGTON — While CMS rolled out new rules for Medicare enrollment and revalidation earlier this week in an effort to rein in fraud, the agency didn't report all of the adverse actions it took against DME providers and many others, according to a new report from HHS' Office of Inspector General.

Part of the problem came from CMS' unawareness of the types of actions it had to report, the OIG said. But in the case of actions against DME suppliers, the reports were ditched in a cost-saving move.

Both federal and state government agencies and health plans are required to report adverse actions to the Healthcare Integrity and Protection Data Bank (HIPDB), a national databank that contains reports of adverse actions against health care practitioners, providers and suppliers. Those actions include licensure and certification actions, exclusions from participation in federal and state health care programs, criminal convictions, civil judgments related to health care and any other adjudicated actions or decisions that the HHS Secretary establishes by regulation.

"The HIPDB plays an important role in preventing the employment of potentially fraudulent or abusive health care providers, so it is important that the information it contains be complete and accurate," the OIG said.

But its report, issued Sept. 21, found that CMS officials thought only adverse actions related to fraud and abuse had to be reported when, in fact, the agency is supposed to report revocations and suspensions of laboratory certifications, provider terminations from participating in Medicare and civil monetary penalties against all types of providers, managed care plans and prescription drug plans.

As of April 30, 2009, the HIPDB contained 5,125 adverse actions against DME suppliers imposed from 1998 through 2008. But the databank contained no adverse actions against DME suppliers taken after 2008, the report said, "although DME fraud is an ongoing issue in Medicare — Medicare paid more than $30 million in fraudulent claims to DME suppliers in 2008 alone."

What's more, the OIG added, CMS officials said the agency quit reporting those adverse actions as a cost-saving measure.