Healthcare Business News

CMS lax on reporting violations to anti-fraud database, OIG says

By Joe Carlson
Posted: September 13, 2012 - 1:15 pm ET

The CMS has done better recently in reporting violations by durable medical equipment suppliers to a national database used to keep fraudsters out of the healthcare system, but an audit says the agency is still not meeting other reporting requirements.

The HHS' inspector general's office says in a four-page follow-up audit that the CMS has not been consistently reporting problems with nursing homes, laboratories, managed-care plans and prescription-drug plans to the Healthcare Integrity and Protection Data Bank.

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The CMS imposed 148 “adverse events” such as exclusion from Medicare and criminal convictions against laboratories in 2007, and 30 such events against managed-care and drug plans between 2006 and 2009—but none of those events was included in the databank as of April 1, the OIG audit found. The CMS also appeared to be reporting violations by nursing homes only on an annual basis, even though those reports are supposed to be made monthly.

The agency has followed the recommendation from a 2010 audit to include and regularly update thousands of adverse events taken against suppliers of durable medical equipment, the auditors said.

The database, which is used by healthcare providers to make sure they are not employing or contracting with prohibited people and organizations, is in the process of being merged with the National Practitioner Data Base because of a consolidation requirement in the Patient Protection and Affordable Care Act. A spokesman from the CMS could not be reached for comment Thursday.

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