Database to track health care fraud

Beginning today, public and private agencies involved in health care services must report any convictions or judgments against them to a new database designed to curtail health care fraud and abuse.The new Healthcare Integrity and Protection Data Bank will contain the following information on health care providers, suppliers and practitioners:

* Civil judgments against them in federal or state courts related to the delivery of a health care item or service.

* Federal or state criminal convictions.

* Actions by federal or state agencies responsible for licensing and certification.

* Records of their exclusion from federal and state health care programs.

"Health plans with access to the data bank will be able to more thoroughly check the qualifications of those with whom they seek to contract, affiliate, hire or credential," said Department of Health and Human Services Inspector General June Gibbs Brown.

The decade-old National Practitioner Data Bank houses reports of medical malpractice settlements as well as actions revoking licenses, clinical privileges and professional society memberships. That data includes more than 133,000 physicians, dentists and other health care practitioners. That database and the new one are operated by the Health Resources and Services Administration.

During the start-up period, those required to report to the new database must provide information on all final actions against them since Aug. 21, 1996, the date of enactment of the Health Insurance Portability and Accountability Act. That act mandated the creation of the database.

The new database began accepting voluntarily submitted reports earlier this year, but the process becomes obligatory today, said Thomas Croft, director of quality assurance in the Bureau of Health Professions at the Health Resources and Services Administration. Croft sets policy and oversees the database's operations, which are handled largely by a private contractor. "We've been registering potential queriers of the data bank since July, and are already up to 2,500 who intend to use it," Croft said.

Requests for information disclosure will not be accepted until January.

Those that must report to the database include: state and federal law enforcement organizations; state and federal agencies that license or certify health care entities; federal agencies that provide payment; and private health plans.

"The entities are in various stages of readiness," Croft said. "Some waited for the final rules to be established, and some have been chomping at the bit for over a year now."

Because there is some overlap in the reporting, as well as in those authorized to query, a single Integrated Querying and Reporting Service will be used with both databases over the World Wide Web.

Access to the new database's reports is limited. The general public will not be able to review the information, but government agencies and private health plans required to report to the database can. The subjects of reports also have access to their own data.

The information can be used for employment, professional review, licensing, certification or registration, fraud and abuse investigation, certification to participate in a government program, and civil and administrative sanctions.

There will be a $10 fee for queries to the database for health care providers, suppliers and practitioners who request information about themselves or their organizations. There will be a $4 fee for queries from private health plans and state agencies seeking information about other entities.

Croft said the database will process more than 1 million requests during its inaugural year, and estimated $6 million in operating costs for the first year, depending on the traffic.

The Web address is For additional information, call (800) 767-6732.


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