Improvements Are Needed To Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent

HHS: May 28, 2013

WHY WE DID THIS STUDY

Health care provider information, including providers’ unique National Provider Identifiers (NPIs), is maintained in the National Plan and Provider Enumeration System (NPPES). To enroll in Medicare, providers must supply their NPIs and other information to CMS to be entered into the Provider Enrollment, Chain and Ownership System (PECOS). Accurate, complete, and consistent provider data in NPPES and PECOS help to ensure the integrity of all health care programs. Previous OIG work has revealed ongoing problems with CMS’s oversight of provider data, sometimes resulting in improper Medicare payments to fraudulently enrolled providers.  Read more