CMS contributed to gaps in a federal database of disciplined health care providers by neglecting to report disciplinary action to the Healthcare Integrity and Protection Data Bank as required by law, according to a new report from HHS' Office of the Inspector General, "ProPublica Blog" reports (Wang, "ProPublica Blog," 9/22).
Background on Data Bank
HIPDB aims to help hospitals and other organizations hire health care providers who are in good legal standing with health care regulations, and Medicare and Medicaid program requirements (Clark, HealthLeaders Media, 9/23).
Federal law requires CMS to update the database with information on:
- Civil monetary penalties levied against health care providers, managed care plans and prescription drug plans;
- Terminations of participation in Medicare; and
- Revocations and suspensions of laboratory certifications.
The inspector general report found that CMS disciplined numerous medical entities but failed to report many of those actions to the database.
Some of the actions that CMS failed to report include:
- 148 sanctions imposed against laboratories in 2007; and
- 30 sanctions imposed against managed care plans and prescription drug plans between January 2006 and July 31, 2009.
Although CMS banned 45 nursing homes from participating in Medicare between 2004 and 2008, the agency did not report the terminations to the database until fall 2009, according to the inspector general report.
The report also noted that a division of CMS that tracks and reports action against Medicare-certified health care providers did not report any disciplinary actions to the database between 2001 and 2008.
According to the report, CMS did not report the actions because it mistakenly believed that it should report only fraud and abuse cases to the database ("ProPublica Blog," 9/22).
The inspector general report recommends that CMS quickly begin reporting all disciplinary actions to HIPDB.
It also calls for CMS to "educate staff and contractors about the types of adverse actions to be reported and the time frames for reporting" (HealthLeaders Media, 9/23).
In a response to the inspector general's office, CMS acknowledged its reporting gaps.
The agency said it will take steps to scale back manual reporting and strengthen the necessary infrastructure for meeting reporting requirements ("ProPublica Blog," 9/22).