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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 | 3 Comments »
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