OIG Highlights Inaccuracy In Medicare Enrollment Databases

According to the OIG, Medicare provider enrollment databases include inaccurate, incomplete, and inconsistent provider data, and -- coupled with insufficient oversight -- “present vulnerabilities in all health care programs”. The OIG reviewed heath care provider information maintained in the National Plan and Provider Enumeration System (NPPES) and the Provider Enrollment, Chain and Ownership System (PECOS). For instance, provider data was inaccurate in 48% of NPPES records and 58% of PECOS records, and this data was inconsistent between NPPES and PECOS for 97% of records (addresses were the source of most inaccuracies and inconsistencies). The OIG recommends that CMS: require Medicare Administrative Contractors to implement program integrity safeguards for Medicare provider enrollment; require more verification of NPPES and PECOS data; and detect and correct inaccurate and incomplete provider data. CMS concurred with the recommendations. The title of the OIG report is: “Improvements Are Needed To Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent”. 

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