WASHINGTON, DC - Energy and Commerce Republican Leader Greg Walden (R-OR), Health Subcommittee Republican Leader Dr. Michael Burgess (R-TX), and Oversight and Investigations Subcommittee Republican Leader Brett Guthrie (R-KY) sent a letter to Centers for Medicare and Medicaid Services (CMS) to request a briefing on efforts to improve the integrity of the application and assignment process of the National Provider Identifier (NPI).
Under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, covered health care providers and plans are required to obtain and use a NPI for certain financial and administrative transactions in addition to helping prevent fraud.
“We have questions, however, about CMS’ oversight of the issuance of NPIs and how this oversight impacts program integrity and the ability of NPIs to be used to help prevent fraud and abuse," wrote Walden, Burgess, and Guthrie.“Recent press reports indicate that individuals have obtained multiple NPI numbers for the purpose of committing healthcare fraud and raise questions about CMS’ oversight of the NPI application process. For instance, in a recent federal prosecution, U.S. v. David Roy Williams, Mr. Williams obtained over 19 NPIs and used them to receive over $4 million in fraudulent healthcare payments from insurers such as Aetna, Cigna, and United Health."
Walden, Burgess, and Guthrie ask that CMS address the following questions, among others, in a briefing by Nov. 15, 2019.
1. The role of the CMS Center for Program Integrity (CPI) in reviewing NPS data for anomalies, outliers, trend analysis, or potential fraud patterns in NPI applications.
2. Since January 2016, the number of complaints CMS and its contractors/representatives are aware of in which the same individual was issued more than one NPI number and the disposition of those complaints.
3. The role of the CMS Enumerator and the structure of the Enumerator staffing. Does the CMS Enumerator compare NPI applications/data to the OIG List of Excluded.
