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CMS Failed to Report Providers' Adverse Actions, Says OIG

Cheryl Clark, for HealthLeaders Media, September 23, 2010

The Centers for Medicare & Medicaid Services took adverse actions against hundreds of healthcare providers, but did not report them to the Healthcare Integrity and Protection Databank as required because the agency did not regard the providers' activities as fraud or abuse.

That's according to a report from the Office of Inspector General this week which recommends that CMS promptly start reporting such events. "Users (of this databank) pay fees for each query they submit to the HIPDB with the expectation that they will receive complete and accurate information in return," the OIG report states.

The HIPDB, which as of 18 months ago contained reports of 389,273 adverse actions, "may be used for employment, affiliation, certification or licensure decisions," the OIG said. Just 5,146 adverse actions of of the 389,273 had been reported by CMS.

The information helps providers select entities who are in good standing with legal healthcare requirements and conditions of participation in Medicare and Medicaid programs.

"The CMS should report all adverse events as required," the investigation summary concludes.

The OIG says CMS neglected to report all of the 148 actions taken against laboratories in 2007 or all of the adverse actions taken against durable medical equipment suppliers in 2008. It did not report any adverse actions taken against 45 nursing homes, which were terminated from participating in the Medicare program from 2004 to 2008, until 2009, "well after the required reporting timeframe."

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