HHS Office of Inspector General finds continuing problems in federal provider-identification databases

Will inaccuracies in the National Plan and Provider Enumeration System (NPPES) create headaches for pharma?

On the verge of when the pharma industry needs to get serious about collecting and aggregating spending data on physicians, the Physician's Payment Sunshine Act, the HHS OIG came out with a report again castigating HHS for the inability of its contractors to maintain federal databases identifying names, affiliations and locations of providers. The OIG report (issued in late May; tip of the hat to SK&A Information for highlighting the study), Improvements Needed to Ensure Provider Enumeration and Medicare Enrollment, found that provider data were inaccurate in 48% of records, and incomplete in 9% of records; there were also inconsistencies affecting nearly all records when NPPES and the provider Enrollment, Chain and Ownership System (PECOS), another HHS database used for provider data.

In truth, the inaccuracies seldom included the National Provider Identifier (NPI), the key ID number for physicians and other providers, and the one that most pharma-industry databases are keyed to; more often, the inaccuracy involved address information. And these databases are more important to the Medicare payments that CMS makes, and for preventing fraud and abuse in that program, than for pharma’s agg-spend requirements. But the continuing difficulty highlights the complexity of keeping track, through regularly updated master-data lists, of the providers that the pharma industry interacts with.