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Healthcare Fraud and Abuse Data Collection Program
By Patricia Trites; MPA, CHBC, CPC
The Healthcare Integrity and Protection Data Bank (HIPDB) were created to coordinate information with the National Practitioner Data Bank (NPDB). Currently, health plans, health maintenance organizations, and federal and state agencies are required to report final adverse actions taken against healthcare providers on a monthly basis.
The NP Database
The database operates under the auspices of DHHS, the Health Resources and Services Administration, and the Bureau of Health Professions. The Secretary of DHHS is responsible for operating this data bank in the same fashion as the NPDB.
Adverse Actions
Five types of final adverse actions against a healthcare provider, supplier, or practitioner are reported into this data bank:
1. civil judgments in federal or state court related to the delivery of a healthcare item or service;
2. federal or state criminal convictions related to the delivery of a healthcare item or service;
3. actions by federal or state agencies responsible for licensing and certification;
4. exclusions from participation in a federal or state healthcare program; and
5. any other adjudicated actions or decisions that the secretary of DHHS establishes by regulations.
Assessment
These actions must be reported, regardless of whether the subject of the report is appealing the action. Federal and state agencies, hospitals, and health plans are permitted to query the HIPDB. This will also lead to increased activities by other federal agencies, including the Internal Revenue Service and the Federal Trade Commission, which can lead to civil and criminal penalties.
Conclusion
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Filed under: Ethics, Quality Initiatives, Research & Development | Tagged: david marcinko, DHHS, FTC, healthcare abuse, healthcare fraud, Healthcare Fraud and Abuse Data Collection Program, NPDB National Practitioner Data Bank, Patricia Trites, www.healthcarefinancials.com |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Just beware malware security concerns with this bank and the three major botnets of 2010: Pushdo, Bredo and Z-bot.
Jason
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Jason,
I could not agree more.
Whatever the financial outlays required for insurance/financial organizational compliance, it may result in very large savings later if affected hospital assets and patient health insurance information is safeguarded against attacks on virtual or real assets.
Elizabeth
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Senator Not Satisfied After Public Access to Doc Discipline Database is Restored
The HHS Health Resources and Services Administration has reposted the public-use file of its National Practitioner Data Bank, but it has done so with conditions that one critic doubts will work and another calls “unacceptable.”
The data bank’s public use file contains de-identified information on disciplinary actions against physicians and, in a statement posted on the databank’s website, HRSA Administrator Mary Wakefield touts this data as being available for statistical analysis and reports on malpractice trends.
Sen. Chuck Grassley (R-Iowa), who has been crusading for the restoration of the public use file, was not satisfied with terms of the data use agreement. “It’s also hard to see how HRSA has the resources to require the return of supposedly misused data or how that would even work,” Grassley said in a news release. “It seems the agency’s time would be better used in making sure the database is up to date and as useful as possible.”
Source: Andis Robeznieks, Modern Healthcare [11/9/11]
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