OIG: PECOS, NPPES data 'inaccurate'

Wednesday, May 29, 2013

WASHINGTON – The Office of the Inspector General (OIG) is calling for improvements to the Provider Enrollment, Chain, and Ownership System (PECOS) and the National Plan and Provider Enumeration System (NPPES), after a sample of stored Medicare provider records contained errors.

In a report issued May 28, the agency also found that CMS did not verify most provider information in either enrollment database.

“Medicare provider data in NPPES and PECOS were often inaccurate and occasionally incomplete and were generally inconsistent between the two databases,” an OIG press release stated.

In PECOS, provider data were inaccurate in 58% of records, while in NPPES, 48% of records were inaccurate.

Moreover, provider data were inconsistent between NPPES and PECOS for 97% of records. The most common inaccuracies were with addresses, necessary for contacting providers and identifying trends in fraud and waste, according to the release.

The OIG recommends that CMS implement program integrity safeguards for Medicare provider enrollment, require more verification of enrollment data, and better detect and correct inaccurate and incomplete data for new and established records, according to the release. CMS concurred with all three recommendations.

Once implemented, PECOS edits, whose start date was recently delayed due to technical issues, will deny claims that contain the names of physicians not enrolled in the system.