Minimum Data Set information identifying providers will be shared with health plans to fight fraud, CMS announces

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Minimum Data Set information identifying providers will be shared with health plans to fight fraud,
Minimum Data Set information identifying providers will be shared with health plans to fight fraud,

To combat fraud and abuse, the Centers for Medicare & Medicaid Services plans to make provider-specific Minimum Data Set information available to health plans, according to a notice in Wednesday's Federal Register.

The MDS is one of 23 records systems that would be affected by the new “routine use” defined by CMS.

Information that may identify care providers and beneficiaries could be shared with insurers and other health benefits providers under the new practice. These disclosures would be meant “to prevent, deter, discover, detect, investigate, examine, prosecute, sue with respect to, defend against, correct, remedy, or otherwise combat fraud, waste, or abuse in such programs,” according to CMS.

The Data Sharing and Partnership Group of CMS would coordinate these disclosures. The DSPG was established in 2012 to help detect fraud by improving data sharing among government and private insurance programs.

“A bad actor may bill Medicare for eight hours of care one day, then bill two other insurance companies each for eight hours on that very same day. Seen separately, as they are now, these billings could appear normal,” said Health and Human Services Secretary Kathleen Sebelius, in announcing the DSPG. “By sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped.”

Comments will be accepted on the proposal through June 27. It will take effect after that date, unless CMS decides to make revisions based on comments. 

Click here to access the Federal Register entry.