OIG: Medicare Provider Databases Need Better Management

The Department of Health and Human Services’ Office of the Inspector General is recommending improvements to management of the agency’s two Medicare provider databases.

In the National Plan and Provider Enumeration System (NPPES) and Provider Enrollment, Chain and Ownership System (PECOS), Medicare provider data were “often inaccurate and occasionally incomplete,” the OIG found in a recent report.

The OIG has previously identified problems with NPPES and PECOS (and their predecessor system), citing them as a possible contributor to improper payments, with some fraud schemers potentially enrolling in the database as providers.

In its latest report, the OIG surveyed a random sample of 170 Medicare providers (out of 987,200) to probe data accuracy and consistency between NPPES and PECOS. (Medicare providers use NPPES to apply for a national provider identifier, or NPI, and then enroll through PECOS.)