Medicare’s doctor records riddled with errors


Washington Wrong addresses, telephone numbers and licensing information for physicians have been found throughout the enrollment systems that Medicare uses to approve pay for beneficiary services, according to federal auditors.

An estimated 58% of enrollment records in the Provider Enrollment, Chain and Ownership System were inaccurate, and 48% of records in the National Plan and Provider Enumeration System had errors, the Dept. of Health and Human Services Office of Inspector General stated in a report published May 28. The records also were inconsistent between the two systems, with nearly all records for health professionals in PECOS and NPPES containing mismatched information in 2010.

“The results of our analyses show that NPPES and PECOS data are not reliable independently or even when combined,” the OIG stated.

Work already is under way to fix NPPES, which physicians use to obtain national provider identifiers that allow them to contract with public and private payers, and PECOS, which allows physicians to participate in Medicare. The Centers for Medicare & Medicaid Services has led a massive effort to verify and correct errors found in PECOS, which contains the records of 1.5 million physicians, other health care professionals and suppliers, a CMS spokesman said. About 460,000 records have been revalidated to date, resulting in 160,000 enrollments being deactivated and 14,000 being revoked.  Read more