Again: Call for CMS to Release Tax Numbers

It's 2022 and still CMS fails to include healthcare organizations' tax numbers. Whether you call them TIN or EIN the numbers are not sensitive in any way, and the Centers for Medicare and Medicaid Services should release them. This is a repost of an article from 2010, more than 3 years after the first NPI Registry data was made public - except, of course, for those tax numbers:

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The NPI Final Rule called for CMS to establish a system that would assign a National Provider Identifier (NPI) number to essentially every healthcare provider in the U.S. (HIPAA "covered entities"): now more than 3 million providers and growing. Great. But it was years before CMS released that data for the industry to use. CarePrecise personnel were at the forefront even back then, calling for CMS to release the data. If necessary, we were ready to fight for it, filing our own request under the Freedom of Information Act (FOIA). Federal agencies can't keep such kinds of data from the public. It's the law. CMS eventually looked at FOIA, and at their provider data, and decided that, sure enough, they were going to have to release it. We and our clients were ecstatic; now the industry would be able to produce the complex crosswalks necessary to actually achieve the efficiencies promised by the Final Rule.

Hurray... except CMS decided not to release one of the most useful data points of all. A provider's federal tax number is hardly a private number. Businesses have to give their tax number on every imaginable type of transaction. Employees see the employer's number on their W-2s. CMS's excuse was that sole proprietors and pretty much all individual practitioners would have to give their Social Security Number, or that busy doctors might type in the SSN in the wrong spot. Fair enough, but, as everyone who works with data knows, it's a piece of cake to parse a tax number field to determine if the number is a SSN or a business tax number. In fact, that's just exactly what CMS does in the Other ID fields of the NPPES (National Plan and Provider Enumeration System) database, replacing 000-00-0000 with a string of equals signs.

Instead of just redacting the SSNs, CMS decided it was best just to wipe clean the complete Employer Identification Number (EIN) field -- just in case some uppity docs got... uppity. Many of us have been hoping that CMS would revisit the issue of this gaping hole in the provider data, but it seems that the issue is to be ignored so that it will just go away.

So, here we are, once again, years into it, asking CMS to release non-SSN tax numbers/EINs so that we -- health systems and health plans large and small, clearinghouses, HIT vendors, medical billing and coding vendors -- can make this data do what it was intended to do for healthcare and for the taxpayers.

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Check out the NPI information at CarePrecise.

Medicare Fraud Steals $60 Billion a Year

Six months after a provider performs a particular medical procedure, they can bill it again. And, exactly six months to the day, the provider photocopies the original claim, changes the date, and sends the scammed claim it off to Medicare.

$60 billion worth of fraud is roughly 10% of the total amount Medicare pays out every year on healthcare for 54 million people. According to a March 7 WIRED article, "Since 2007 more than 2,300 providers have been charged with fleecing Medicare, and more than 1800 defendants have been convicted of felony offences, ranging from claiming phantom services to performing unnecessary surgeries."

Among CarePrecise Clients are the Federal Bureau of Investigation and state anti-fraud law enforcement bodies. CarePrecise provides comprehensive data on healthcare providers.

How will ever stop these scams? There are just too many of them for CMS' dedicated investigators to keep up. But the government is getting help from hundreds of citizens: whistle-blower lawsuits allow any medical office staff or other insider to sue their employer and collect 15% to 30% of the settlement. The number of bounty hunters is growing; in 2014 there were 469 such settlements resulting in $2.2 billion in fines.

Professional whistle-blower lawyers can help skittish employees to rat correctly, but they may not have the investigative chops. Now one clever business has begun to turn medical office whistle-blowing into a growth industry. National Healthcare Analysis Group may do more to help recover this money than has been possible in the past by organizing the process and "packaging" it. Read more about it...

91 Charged With $295 Million Medicare Fraud

Ninety-one doctors, nurses and others were charged in a blockbuster sting operation, with arrests unfolding over three weeks and culminating in 70 arrests last week. In 2007, a strike force was set up between the Department of Justice and the Department of Health and Human Services to identify and build federal fraud cases to fight criminal abuse of federal healthcare programs. U.S. Attorney General Eric Holder said that arrests were made in eight US cities involving more than $295 million in stolen funds.

Almost half of those charged were part of a Florida ring that recruited healthcare providers to refer patients to a mental health center, in some cases threatening residents of a halfway house with eviction if they refused the unnecessary care. Another case involved $3.4 million in unnecessary physical therapy by two Brooklyn physicians.

On September 1, officials in Detroit charged 18 physicians, nurses, clinic owners and other medical professionals for submitting $28 million in false claims to Medicare. Just one day earlier, the owner of a Houston, Texas durable medical equipment business was sentenced to 97 months in prison for his role in a Medicare fraud scheme.

In all, the strike force, known as Health Care Fraud Prevention and Enforcement Action Team (HEAT), has charged 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion.

When providers have been convicted of fraud and certain other infractions and delinquencies, their names are placed on the List of Excluded Individuals/Entities (LEIE) database. CarePrecise compiles this data into its comprehensive database of U.S. healthcare providers, identifying excluded providers' NPI numbers, phone and fax numbers.

Read the full story on the HHS website.

Medicare Wins in Vegas Fraud Case

Rakesh Nathu, a Las Vegas oncologist, settled his fraud case with the Justice Department yesterday for $5.7 million plus interest. Dr. Nathu was accused of submitting false claims to Medicare, TRICARE and the Federal Employees Health Plan for various radiation oncology services, including intensity modulated radiation therapy, and double billing for services. We hope he did better at the craps table. The government has recovered more than $7.3 billion in False Claim Act cases since 2009.

Among CarePrecise clients are law enforcement agencies working on federal and private payer fraud investigations. As a result of work done for our clients, we developed a means of matching the federal fraud conviction list with providers' NPI records, and associating certain demographic data with practice locations to help visualize patterns. Late in 2010 we began including the fraud data in our CarePrecise Access Complete dataset, and the additional economic data in CarePrecise Gold products. Now included is a flag that indicates provider records whose data strongly suggest a match with the federal LEIE (List of Excluded Individuals/Entities) database. Other features help investigators track providers' licensing, credentials, specialty codes, enrollment in the PECOS database, and numerous other functions.

Read the Justice Department news release.

Call for CMS to Release Tax Number Data

The NPI Final Rule called for CMS to establish a system that would assign a National Provider Identifier (NPI) number to essentially every healthcare provider in the U.S. (HIPAA "covered entities"): now more than 3 million providers and growing. Great. But it was years before CMS released that data for the industry to use. CarePrecise personnel were at the forefront even back then, calling for CMS to release the data. If necessary, we were ready to fight for it, filing our own request under the Freedom of Information Act (FOIA). Federal agencies can't keep such kinds of data from the public. It's the law. CMS eventually looked at FOIA, and at their provider data, and decided that, sure enough, they were going to have to release it. We and our clients were ecstatic; now the industry would be able to produce the complex crosswalks necessary to actually achieve the efficiencies promised by the Final Rule.

Hurray... except CMS decided not to release one of the most useful data points of all. A provider's federal tax number is hardly a private number. Businesses have to give their tax number on every imaginable type of transaction. Employees see the employer's number on their W-2s. CMS's excuse was that sole proprietors and pretty much all individual practitioners would have to give their Social Security Number, or that busy doctors might type in the SSN in the wrong spot. Fair enough, but, as everyone who works with data knows, it's a piece of cake to parse a tax number field to determine if the number is a SSN or a business tax number.In fact, that's just exactly what CMS does in the Other ID fields of the NPPES (National Plan and Provider Enumeration System) database, replacing 000-00-0000 with a string of equals signs.

Instead of just redacting the SSNs, CMS decided it was best just to wipe clean the complete Employer Identification Number (EIN) field -- just in case some uppity docs got... uppity. Many of us have been hoping that CMS would revisit the issue of this gaping hole in the provider data, but it seems that the issue is to be ignored so that it will just go away.

So, here we are, once again, years into it, asking CMS to release non-SSN tax numbers/EINs so that we -- health systems and health plans large and small, clearinghouses, HIT vendors, medical billing and coding vendors -- can make this data do what it was intended to do for healthcare and for the taxpayers.

Clinical Terminology Dictionary to be Available

Kaiser Permanente announced a few weeks ago its 75,000-term clinical terminology database, the Convergent Medical Terminology dictionary (CMT), to become freely available through HHS. Including maps to additional clinical vocabulary sets, including SNOMED-CT, the database enables links to ICD-9, ICD-10 and other code sets. Many millions of dollars and 16 years in development, the CMT will be freely distributed by the Department of Health and Human Services. Watch here for more information as the dictionary becomes available.

PHR-Lite for Medicare Members

The Centers for Medicare and Medicaid Services has launched a new "Blue Button" feature on its MyMedicare.gov website. The app makes it possible for the 47 million Medicare members to access, print or download specific medical information. "Having ready access to personal health information from Medicare claims can help beneficiaries understand their medical history and partner more effectively with providers," the agency says. Having access to Medicare claims means having access to a virtually complete record of your healthcare incidents, the next-best thing to a personal health record (PHR), and it's updated for you by the government. Sweet!