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Archives for September 2012

Consistency Lacking in Healthcare Data Bank Reporting

On September 12, 2012, the Office of Inspector General (OIG) issued a report regarding the Healthcare Integrity and Protection Data Bank (HIPDB).  The report was a follow up memorandum to a 2010 report where the OIG found that the Centers for Medicare and Medicaid Services (CMS) did not report all adverse actions to the HIPDB as required by law.  The OIG’s findings indicate that CMS improved reporting for durable medical equipment (DME) suppliers but did not improve adverse action reporting for other types of providers.

The HIPDB is available as a resource to agencies, health plans, and individuals.  The purpose of the HIPDB is to provide a central reporting tool for adverse actions against potentially fraudulent and abusive providers.  Under current law, the HIPDB data will ultimately be transferred to the National Practitioner Data Bank (NPDB).  At that time, the HIPDB will no longer be in operation and the NPDB will be the central location for adverse action queries.  According to the OIG’s report OEI-07-09-00292, the types of adverse actions that must be reported under law include “licensure and certification actions, exclusions from participation in Federal and State health care programs, criminal convictions, civil judgments related to health care, and any other adjudicated actions of decision that the Secretary establishes by regulation.”  There are specific reporting time limits when an adverse action is taken.

In preparing its follow up report, the OIG compared reporting data from 2009 with reporting data from 2012.  The OIG concluded that “the number, frequency, and types of reports indicate compliance with Federal requirements” for DME suppliers; however, the OIG also concluded that “CMS may no longer be reporting any nursing home terminations to the HIPDB.”  Further, data comparisons indicated that the HIPDB is missing reports of adverse actions taken against other types of providers, including prescription drug plans, laboratories, and managed care plans.

As a result of its follow up investigation, the OIG decided to further recommend that CMS report all adverse actions as required by law.

Entities that regularly query the HIPDB for information about providers and solely rely on those query results should exercise caution.  The OIG provides an online search for exclusions.  In addition, the Georgia Secretary of State allows for corporation searches to verify corporate information.  It is recommended that entities exercise due diligence to protect themselves from association with providers who are excluded or have a history of adverse actions.

Alternatives to Medicaid Expansion

Governors around the country are looking for alternatives to Medicaid expansion in light of the Supreme Court’s decision to uphold key provisions of the Affordable Care Act. One alternative being considered by several governors, including Georgia’s Governor Deal, is a Medicaid block grant. A block grant is a lump sum payment to the states that typically comes with more freedom from federal government rules.

Proponents of block grants advocate for the increased flexibility and the ability for each state to use the funds in a manner that best fits its individual needs. Currently, if states wish to modify the federal Medicaid rules they must submit for a waiver, an application process that can take more than a year. Opponents of block grants argue that block grants do not take into account economic or population changes. Opponents also point to other block grants such as Temporary Assistance for Needy Families (“TANF”), which have not received an increase in dollar amount since it was established in 1996. Further, block grants are easier for Congress to eliminate because the lack of rules also means it is difficult to measure the grant’s effectiveness across states and years.

Currently, Georgia has not committed to Medicaid expansion under the Affordable Care Act. Instead, Governor Deal has decided to postpone the decision until after the November election. Although a block grant presents a viable alternative to Medicaid expansion, it may not be the best option for Georgia because expenditures beyond the amount of the block grant must be covered by the state. Georgia is currently facing a Medicaid budget shortfall, and the responsibility for Medicaid expenditures beyond the amount of a block grant would magnify the Medicaid budget crisis.

Jeyaram & Associates will continue to monitor the status of the Medicaid program in Georgia.