Thursday, September 23, 2010

Inspector General Reports CMS to who?? or

Failure is an OPTION


A recent report in iHealthbeat from the California Health Care Foundation states that CMS did notcomply with identifying and reporting 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).

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Since CMS cannot keep up with present reporting requirements, why should anyone believe CMS will be able to comply with  HHS’ demands for meaningful use reporting, or P4P, or outcome statistics. 

The system is set up to FAIL !!


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.

Report Findings

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).


Tony West Health and Human Services Secretary Kathleen Sebelius (C) is joined by HHS Inspector General Daniel Levinson (L) and Assistant Attorney General Tony West to highlight the Obama Administration's work to fight Medicare fraud October 15, 2009 in Washington, DC. The departments of Justice and Health and Human Services have been working together closely to fight medical identity theft and other related crimes with the Health Care Fraud Prevention and Enforcement Action Team (HEAT).

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).

CMS Response

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).

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