[Federal Register: December 27, 2006 (Volume 71, Number 248)]
[Notices]
[Page 77759-77765]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27de06-66]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Report of a Modified or Altered System of
Records
AGENCY: Department of Health and Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS).
ACTION: Notice of a Modified or Altered System of Records (SOR).
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SUMMARY: In accordance with the requirements of the Privacy Act of
1974, we are proposing to modify or alter a SOR, ``CMS Fraud
Investigation Database (FID), System No. 09-70-0527,'' most recently
modified at 67 FR 65795 (October 28, 2002). We propose to modify
existing routine use number 1 that permits disclosure to agency
[[Page 77760]]
contractors and consultants to include disclosure to CMS grantees who
perform a task for the agency. CMS grantees, charged with completing
projects or activities that require CMS data to carry out that
activity, are classified separate from CMS contractors and/or
consultants. The modified routine use will remained as routine use
number 1. We will delete routine use number 2 authorizing disclosure to
support constituent requests made to a congressional representative. If
an authorization for the disclosure has been obtained from the data
subject, then no routine use is needed. The Privacy Act allows for
disclosures with the ``prior written consent'' of the data subject.
We propose to broaden the scope of the disclosure provisions of
this system by adding a routine use to permit the release of
information to another Federal and state agencies to: (1) Contribute to
the accuracy of CMS' proper payment of Medicare benefits; (2) enable
such agency to administer a Federal health benefits program, and/or (3)
assist Federal/state Medicaid programs within the state. We will
broaden the scope of routine uses number 4 and 5 authorizing
disclosures to combat fraud and abuse in the Medicare and Medicaid
programs to include combating ``waste'' which refers to specific
beneficiary/recipient practices that result in unnecessary cost to all
Federally-funded health benefit programs.
We are modifying the language in the remaining routine uses to
provide a proper explanation as to the need for the routine use and to
provide clarity to CMS's intention to disclose individual-specific
information contained in this system. The routine uses will then be
prioritized and reordered according to their usage. We will also take
the opportunity to update any sections of the system that were affected
by the recent reorganization or because of the impact of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA)
(Pub. L. 108-173) provisions and to update language in the
administrative sections to correspond with language used in other CMS
SORs.
The primary purpose of the system of records is to collect and
maintain information to: (1) Identify if a violation(s) of a provision
of the Social Security Act (the Act) or a related penal or civil
provision of the United States Code (U.S.C.) related to Medicare (Title
XVIII), Medicaid (Title XIX), HMO/Managed Care (Title XX), and
Children's Health Insurance Program (Title XXI) have been committed;
(2) determine if HHS has made a proper payment as prescribed under
applicable sections of the Act; (3) determine whether these programs
have been abused; and (4) coordinate investigations related to
Medicare, Medicaid, HMO/Managed Care, and Children's Health Insurance
Program; (5) prevent duplications investigatory efforts; and (5)
provide case file material to the HHS Office of the Inspector General
when a case is referred for fraud investigation. Information retrieved
from this system of records will also be disclosed to: (1) Support
regulatory, reimbursement, and policy functions performed within the
Agency or by a contractor, consultant, or a CMS grantee; (2) assist
another Federal and/or state agency, agency of a state government, an
agency established by state law, or its fiscal agent; (3) support
litigation involving the Agency related to this system of records; and
(4) combat fraud, waste, and abuse in certain health care programs. We
have provided background information about the modified system in the
SUPPLEMENTARY INFORMATION section below. Although the Privacy Act
requires only that CMS provide an opportunity for interested persons to
comment on the proposed routine uses, CMS invites comments on all
portions of this notice. See ``Effective Dates'' section for comment
period.
Effective Dates: CMS filed a modified or altered system report with
the Chair of the House Committee on Government Reform and Oversight,
the Chair of the Senate Committee on Homeland Security & Governmental
Affairs, and the Administrator, Office of Information and Regulatory
Affairs, Office of Management and Budget (OMB) on December 20, 2006. To
ensure that all parties have adequate time in which to comment, the
modified system, including routine uses, will become effective 30 days
from the publication of the notice, or 40 days from the date it was
submitted to OMB and Congress, whichever is later, unless CMS receives
comments that require alterations to this notice.
ADDRESSES: The public should address comments to: CMS Privacy Officer,
Division of Privacy Compliance, Enterprise Architecture and Strategy
Group, Office of Information Services, CMS, Room N2-04-27, 7500
Security Boulevard, Baltimore, Maryland 21244-1850. Comments received
will be available for review at this location, by appointment, during
regular business hours, Monday through Friday from 9 a.m.-3 p.m.,
eastern time zone.
FOR FURTHER INFORMATION CONTACT: Tara Ross, Health Insurance
Specialist, Program Integrity Group, Office of Financial Management,
CMS, Mail Stop C3-02-16, 7500 Security Boulevard, Baltimore, Maryland
21244-1850. The telephone number is (410) 786-9530 or e-mail
tara.ross@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Description of the Modified or Altered System of Records
A. Statutory and Regulatory Basis for SOR
This system was established under the authority of sections 205,
1106, 1107, 1815, 1816, 1833, 1842, 1872, 1874, 1876, 1877, and 1902 of
the Social Security Act (Title 42 U.S.C. sections 405, 1306, 1307,
1395g, 1395h, 1395l, 1395u, 1395ii, 1395kk, 1395mm, 1395nn, and 1396a).
B. Collection and Maintenance of Data in the System
Individuals alleged to have violated provision of the Act related
to Medicare (Title XVIII), Medicaid (Title XIX), HMO/Managed Care
(Title XX), and Children's Health Insurance Program (Title XXI) or
other criminal/civil statutes as they pertain to the Social Security
Act (the Act) programs where substantial basis for criminal/civil
prosecution exist, defendants in criminal prosecution cases, or persons
alleged to have abused the programs. The system contains the name, work
address, work phone number, social security number, Unique Provider
Identification Number (UPIN), and other identifying demographics of
individuals alleged to have violated provision of the Act or persons
alleged to have abused Medicare and/or Medicaid programs.
II. Agency Policies, Procedures, and Restrictions on the Routine Use
A. Agency Policies, Procedures, and Restrictions on the Routine Use
The Privacy Act permits us to disclose information without an
individual's consent if the information is to be used for a purpose
that is compatible with the purpose(s) for which the information was
collected. Any such disclosure of data is known as a ``routine use.''
The government will only release FID information that can be associated
with an individual as provided for under ``Section III. Proposed
Routine Use Disclosures of Data in the System.'' Both individually
identifiable and non-individually-identifiable data may be disclosed
under a routine use.
We will only disclose the minimum personal data necessary to
achieve the purpose of FID. CMS has the following policies and
procedures concerning disclosures of information that will be
maintained in the system. Disclosure of
[[Page 77761]]
information from the system will be approved only to the extent
necessary to accomplish the purpose of the disclosure and only after
CMS:
1. Determines that the use or disclosure is consistent with the
reason the data are being collected; e.g., is to identify if a
violation(s) of a provision of the Social Security Act or a related
penal or civil provision of the United States Code.
2. Determines that:
a. the purpose for which the disclosure is to be made can only be
accomplished if the record is provided in individually identifiable
form;
b. the purpose for which the disclosure is to be made is of
sufficient importance to warrant the effect and/or risk on the privacy
of the individual that additional exposure of the record might bring;
and
c. there is a strong probability that the proposed use of the data
would in fact accomplish the stated purpose(s).
3. Requires the information recipient to:
a. establish administrative, technical, and physical safeguards to
prevent unauthorized use or disclosure of the record;
b. remove or destroy at the earliest time all individually-
identifiable information; and
c. agree to not use or disclose the information for any purpose
other than the stated purpose under which the information was
disclosed.
4. Determines that the data are valid and reliable.
III. Proposed Routine Use Disclosures of Data in the System
A. The Privacy Act allows us to disclose information without an
individual's consent if the information is to be used for a purpose
that is compatible with the purpose(s) for which the information was
collected. Any such compatible use of data is known as a ``routine
use.'' The proposed routine uses in this system meet the compatibility
requirement of the Privacy Act. We are proposing to establish the
following routine use disclosures of information maintained in the
system:
1. To support Agency contractors, consultants, or grantees that
have been contracted by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this system and who need access
to the records in order to assist CMS.
We contemplate disclosing information under this routine use only
in situations in which CMS may enter into a contractual or similar
agreement with a third party to assist in accomplishing a CMS function
relating to purposes for this system.
CMS occasionally contracts out certain of its functions when doing
so would contribute to effective and efficient operations. CMS must be
able to give a contractor, consultant, or grantee whatever information
is necessary for the contractor, consultant, or grantee to fulfill its
duties. In these situations, safeguards are provided in the contract
prohibiting the contractor, consultant, or grantee from using or
disclosing the information for any purpose other than that described in
the contract and requires the contractor or consultant to return or
destroy all information at the completion of the contract.
2. To assist another Federal or state agency, agency of a state
government, an agency established by state law, or its fiscal agent to:
a. contribute to the accuracy of CMS's proper payment of Medicare
benefits,
b. enable such agency to administer a Federal health benefits
program, or as necessary to enable such agency to fulfill a requirement
of a Federal statute or regulation that implements a health benefits
program funded in whole or in part with Federal funds, and/or
c. assist Federal/state Medicaid programs within the state.
Other Federal or State agencies in their administration of a
Federal health program may require FID information in order to support
evaluations and monitoring of Medicare claims information of
beneficiaries, including proper payment for services provided.
FID data may be disclosed to a state agency, agency of a state
government, an agency established by state law, or its fiscal agent for
purposes of ensuring that no payments are made with respect to any item
or service furnished by an individual during the period when excluded
from participation in Medicare and other Federal and state health care
programs.
FID data may potentially be released to the state only on those
individuals who are either individuals excluded from participation in
the Medicare and other Federal and state health care programs, or
employers of excluded individuals, or are legal residents of the State,
irrespective of the location of provider or supplier furnishing items
or services.
3. To support the Department of Justice (DOJ), court or
adjudicatory body when:
a. the Agency or any component thereof, or
b. any employee of the Agency in his or her official capacity, or
c. any employee of the Agency in his or her individual capacity
where the DOJ has agreed to represent the employee, or
d. the United States Government is a party to litigation or has an
interest in such litigation, and by careful review, CMS determines that
the records are both relevant and necessary to the litigation and that
the use of such records by the DOJ, court or adjudicatory body is
compatible with the purpose for which the agency collected the records.
Whenever CMS is involved in litigation, or occasionally when
another party is involved in litigation and CMS's policies or
operations could be affected by the outcome of the litigation, CMS
would be able to disclose information to the DOJ, court, or
adjudicatory body involved.
4. To support a CMS contractor that assists in the administration
of a CMS-administered health benefits program, or to a grantee of a
CMS-administered grant program, when disclosure is deemed reasonably
necessary by CMS 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.
We contemplate disclosing information under this routine use only
in situations in which CMS may enter into a contract or grant with a
third party to assist in accomplishing CMS functions relating to the
purpose of combating fraud, waste, and abuse.
CMS occasionally contracts out certain of its functions when doing
so would contribute to effective and efficient operations. CMS must be
able to give a contractor or grantee whatever information is necessary
for the contractor or grantee to fulfill its duties. In these
situations, safeguards are provided in the contract prohibiting the
contractor or grantee from using or disclosing the information for any
purpose other than that described in the contract and requiring the
contractor or grantee to return or destroy all information.
5. To support another Federal agency or to an instrumentality of
any governmental jurisdiction within or under the control of the United
States (including any state or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste, or abuse in a program funded in whole or in part by Federal
funds, when disclosure is deemed reasonably necessary by CMS to
prevent, deter, discover, detect, investigate, examine, prosecute, sue
with respect to, defend against, correct,
[[Page 77762]]
remedy, or otherwise combat fraud, waste, or abuse in such programs.
Other agencies may require FID information for the purpose of
combating fraud, waste, and abuse in such Federally-funded programs.
B. Additional Provisions Affecting Routine Use Disclosures
To the extent this system contains Protected Health Information
(PHI) as defined by HHS regulation ``Standards for Privacy of
Individually Identifiable Health Information'' (45 CFR parts 160 and
164, subparts A and E) 65 FR 82462 (12-28-00). Disclosures of such PHI
that are otherwise authorized by these routine uses may only be made
if, and as, permitted or required by the ``Standards for Privacy of
Individually Identifiable Health Information.'' (See 45 CFR 164-
512(a)(1)).
In addition, our policy is to prohibit release even of not directly
identifiable information, except pursuant to one of the routine uses or
if required by law, if we determine there is a possibility that an
individual can be identified through implicit deduction based on small
cell sizes (instances where the patient population is so small that
individuals who are familiar with the enrollees could, because of the
small size, use this information to deduce the identity of the
beneficiary).
IV. Safeguards
CMS has safeguards in place for authorized users and monitors such
users to ensure against unauthorized use. Personnel having access to
the system have been trained in the Privacy Act and information
security requirements. Employees who maintain records in this system
are instructed not to release data until the intended recipient agrees
to implement appropriate management, operational and technical
safeguards sufficient to protect the confidentiality, integrity and
availability of the information and information systems and to prevent
unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations may apply but are not limited to: the Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: all pertinent National
Institute of Standards and Technology publications; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
V. Effects of the Modified System of Records on Individual Rights
CMS proposes to modify this system in accordance with the
principles and requirements of the Privacy Act and will collect, use,
and disseminate information only as prescribed therein. Data in this
system will be subject to the authorized releases in accordance with
the routine uses identified in this system of records.
CMS will take precautionary measures (see item IV above) to
minimize the risks of unauthorized access to the records and the
potential harm to individual privacy or other personal or property
rights of patients whose data are maintained in the system. CMS will
collect only that information necessary to perform the system's
functions. In addition, CMS will make disclosure from the proposed
system only with consent of the subject individual, or his/her legal
representative, or in accordance with an applicable exception provision
of the Privacy Act. CMS, therefore, does not anticipate an unfavorable
effect on individual privacy as a result of information relating to
individuals.
Dated: December 19, 2006.
John R. Dyer,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NUMBER: 09-70-0527.
SYSTEM NAME:
``Centers for Medicare & Medicaid Services (CMS) Fraud
Investigation Database (FID),'' HHS/CMS/OFM.
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive Data.
SYSTEM LOCATION:
Centers for Medicare & Medicaid Services (CMS) Data Center, 7500
Security Boulevard, North Building, First Floor, Baltimore, Maryland
21244-1850, and at various other remote locations.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
Individuals alleged to have violated provision of the Act related
to Medicare (Title XVIII), Medicaid (Title XIX), HMO/Managed Care
(Title XX), and Children's Health Insurance Program (Title XXI) or
other criminal/civil statutes as they pertain to the Act programs where
substantial basis for criminal/civil prosecution exist, defendants in
criminal prosecution cases, or persons alleged to have abused the
programs.
CATEGORIES OF RECORDS IN THE SYSTEM:
The system contains the name, work address, work phone number,
social security number, Unique Provider Identification Number (UPIN),
and other identifying demographics of individuals alleged to have
violated provision of the Act or persons alleged to have abused
Medicare and/or Medicaid programs.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
This system was established under the authority of sections 205,
1106, 1107, 1815, 1816, 1833, 1842, 1872, 1874, 1876, 1877, and 1902 of
the Act (Title 42 United States Code (U.S.C.) sections 405, 1306, 1307,
1395g, 1395h, 1395l, 1395u, 1395ii, 1395kk, 1395mm, 1395nn, and 1396a).
PURPOSE(S) OF THE SYSTEM:
The primary purpose of the system of records is to collect and
maintain information to: (1) Identify if a violation(s) of a provision
of the Social Security Act (the Act) or a related penal or civil
provision of the U.S.C. related to Medicare (Title XVIII), Medicaid
(Title XIX), HMO/Managed Care (Title XX), and Children's Health
Insurance Program (Title XXI) have been committed; (2) determine if HHS
has made a proper payment as prescribed under applicable sections of
the Act; (3) determine whether these programs have been abused; and (4)
coordinate investigations related to Medicare, Medicaid, HMO/Managed
Care, and Children's Health Insurance Program; (5) prevent duplications
investigatory efforts; and (5) provide case file material to the HHS
Office of the Inspector General when a case is referred for fraud
investigation. Information retrieved from this system of records will
also be disclosed to: (1) Support regulatory, reimbursement, and policy
functions performed within the Agency or by a contractor, consultant,
or a CMS grantee; (2) assist another Federal and/or state agency,
agency of a state government, an agency established by state law, or
its fiscal agent; (3) support litigation involving the Agency related
to this system of records; and (4) combat fraud, waste, and abuse in
certain health care programs.
[[Page 77763]]
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES
OR USERS AND THE PURPOSES OF SUCH USES:
A. The Privacy Act allows us to disclose information without an
individual's consent if the information is to be used for a purpose
that is compatible with the purpose(s) for which the information was
collected. Any such compatible use of data is known as a ``routine
use.'' The proposed routine uses in this system meet the compatibility
requirement of the Privacy Act. We are proposing to establish the
following routine use disclosures of information maintained in the
system:
1. To support Agency contractors, consultants, or grantees that
have been contracted by the Agency to assist in accomplishment of a CMS
function relating to the purposes for this system and who need access
to the records in order to assist CMS.
2. To assist another Federal or state agency, agency of a state
government, an agency established by state law, or its fiscal agent to:
a. contribute to the accuracy of CMS's proper payment of Medicare
benefits,
b. enable such agency to administer a Federal health benefits
program, or as necessary to enable such agency to fulfill a requirement
of a Federal statute or regulation that implements a health benefits
program funded in whole or in part with Federal funds, and/or
c. assist Federal/state Medicaid programs within the state.
3. To support the Department of Justice (DOJ), court or
adjudicatory body when:
a. the Agency or any component thereof, or
b. any employee of the Agency in his or her official capacity, or
c. any employee of the Agency in his or her individual capacity
where the DOJ has agreed to represent the employee, or
d. the United States Government is a party to litigation or has an
interest in such litigation, and by careful review, CMS determines that
the records are both relevant and necessary to the litigation and that
the use of such records by the DOJ, court or adjudicatory body is
compatible with the purpose for which the agency collected the records.
4. To support a CMS contractor that assists in the administration
of a CMS-administered health benefits program, or to a grantee of a
CMS-administered grant program, when disclosure is deemed reasonably
necessary by CMS to prevent, deter, discover, detect, investigate,
examine, prosecute, sue with respect to, defend against, correct,
remedy, or otherwise combat fraud, waste, and abuse in such programs.
5. To support another Federal agency or to an instrumentality of
any governmental jurisdiction within or under the control of the United
States (including any state or local governmental agency), that
administers, or that has the authority to investigate potential fraud,
waste, and abuse in a program funded in whole or in part by Federal
funds, when disclosure is deemed reasonably necessary by CMS to
prevent, deter, discover, detect, investigate, examine, prosecute, sue
with respect to, defend against, correct, remedy, or otherwise combat
fraud, waste, and abuse in such programs.
B. Additional Provisions Affecting Routine Use Disclosures
To the extent this system contains Protected Health Information
(PHI) as defined by HHS regulation ``Standards for Privacy of
Individually Identifiable Health Information'' (45 CFR parts 160 and
164, subparts A and E) 65 FR 82462 (12-28-00). Disclosures of such PHI
that are otherwise authorized by these routine uses may only be made
if, and as, permitted or required by the ``Standards for Privacy of
Individually Identifiable Health Information.'' (See 45 CFR 164-512 (a)
(1)).
In addition, our policy will be to prohibit release even of data
not directly identifiable, except pursuant to one of the routine uses
or if required by law, if we determine there is a possibility that an
individual can be identified through implicit deduction based on small
cell sizes (instances where the patient population is so small that
individuals could, because of the small size, use this information to
deduce the identity of the beneficiary).
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING,
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
All records are stored on magnetic media.
RETRIEVABILITY:
All records are accessible by UPIN/NPI or alpha (name) search. This
system supports both on-line and batch access.
SAFEGUARDS:
CMS has safeguards in place for authorized users and monitors such
users to ensure against unauthorized use. Personnel having access to
the system have been trained in the Privacy Act and information
security requirements. Employees who maintain records in this system
are instructed not to release data until the intended recipient agrees
to implement appropriate management, operational and technical
safeguards sufficient to protect the confidentiality, integrity and
availability of the information and information systems and to prevent
unauthorized access.
This system will conform to all applicable Federal laws and
regulations and Federal, HHS, and CMS policies and standards as they
relate to information security and data privacy. These laws and
regulations may apply but are not limited to: the Privacy Act of 1974;
the Federal Information Security Management Act of 2002; the Computer
Fraud and Abuse Act of 1986; the Health Insurance Portability and
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the
corresponding implementing regulations. OMB Circular A-130, Management
of Federal Resources, Appendix III, Security of Federal Automated
Information Resources also applies. Federal, HHS, and CMS policies and
standards include but are not limited to: all pertinent National
Institute of Standards and Technology publications; the HHS Information
Systems Program Handbook and the CMS Information Security Handbook.
RETENTION AND DISPOSAL:
Records are maintained for a period of 15 years. All claims-related
records are encompassed by the document preservation order and will be
retained until notification is received from DOJ.
SYSTEM MANAGER AND ADDRESS:
Director, Program Integrity Group, Office of Financial Management,
CMS, Mail Stop C3-02-16, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
NOTIFICATION PROCEDURE:
For purpose of access, the subject individual should write to the
system manager who will require the system name, social security number
(SSN) or UPIN, address, date of birth, and sex, and for verification
purposes, the subject individual's name (woman's maiden name, if
applicable). Furnishing the SSN is voluntary, but it may make searching
for a record easier and prevent delay.
RECORD ACCESS PROCEDURE:
For purpose of access, use the same procedures outlined in
Notification Procedures above. Requestors should also reasonably
specify the record contents being sought. (These procedures are in
accordance with
[[Page 77764]]
Department regulation 45 CFR 5b.5(a)(2)).
CONTESTING RECORD PROCEDURES:
The subject individual should contact the system manager named
above, and reasonably identify the record and specify the information
to be contested. State the corrective action sought and the reasons for
the correction with supporting justification. (These procedures are in
accordance with Department regulation 45 CFR 5b.7).
RECORD SOURCE CATEGORIES:
Sources of information contained in this records system include
data collected from FID computer files as transmitted by the contractor
sites.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
HHS claims exemption of certain records (case files on active fraud
investigations) in the system from notification and access procedures
under 5 U.S.C. 522a (k) (2) inasmuch as these records are investigatory
materials compiled for program (law) enforcement in anticipation of a
criminal or administrative proceedings. (See Department Regulation (45
CFR 5b.11))
Appendix A. Health Insurance Claims
Medicare records are maintained at the CMS Central Office (see
section 1 below for the address). Health Insurance Records of the
Medicare program can also be accessed through a representative of the
CMS Regional Office (see section 2 below for addresses). Medicare
claims records are also maintained by private insurance organizations
that share in administering provisions of the health insurance
programs. These private insurance organizations, referred to as
carriers and intermediaries, are under contract to the Centers for
Medicare & Medicaid Services and the Social Security Administration to
perform specific task in the Medicare program (see section three below
for addresses for intermediaries, section four addresses the carriers,
and section five addresses the Payment Safeguard Contractors.
I. Central Office Address
CMS Data Center, 7500 Security Boulevard, North Building, First
Floor, Baltimore, Maryland 21244-1850.
II. CMS Regional Offices
Boston Region--Connecticut, Maine, Massachusetts, New Hampshire,
Rhode Island, Vermont. John F. Kennedy Federal Building, Room 1211,
Boston, Massachusetts 02203. Office Hours: 8:30 a.m.-5 p.m.
New York Region--New Jersey, New York, Puerto Rico, Virgin Islands.
26 Federal Plaza, Room 715, New York, New York 10007, Office Hours:
8:30 a.m.-5 p.m.
Philadelphia Region--Delaware, District of Columbia, Maryland,
Pennsylvania, Virginia, West Virginia. Post Office Box 8460,
Philadelphia, Pennsylvania 19101. Office Hours: 8:30 a.m.-5 p.m.
Atlanta Region--Alabama, North Carolina, South Carolina, Florida,
Georgia, Kentucky, Mississippi, Tennessee. 101 Marietta Street, Suite
702, Atlanta, Georgia 30223, Office Hours: 8:30 a.m.-4:30 p.m.
Chicago Region--Illinois, Indiana, Michigan, Minnesota, Ohio,
Wisconsin. Suite A-824, Chicago, Illinois 60604. Office Hours: 8 a.m.-
4:45 p.m.
Dallas Region--Arkansas, Louisiana, New Mexico, Oklahoma, Texas,
1200 Main Tower Building, Dallas, Texas. Office Hours: 8 a.m.-4:30 p.m.
Kansas City Region--Iowa, Kansas, Missouri, Nebraska. New Federal
Office Building, 601 East 12th Street Room 436, Kansas City, Missouri
64106. Office Hours: 8 a.m.-4:45 p.m.
Denver Region--Colorado, Montana, North Dakota, South Dakota, Utah,
Wyoming. Federal Office Building, 1961 Stout St Room 1185, Denver,
Colorado 80294. Office Hours: 8 a.m.-4:30 p.m.
San Francisco Region--American Samoa, Arizona, California, Guam,
Hawaii, Nevada. Federal Office Building, 10 Van Ness Avenue, 20th
Floor, San Francisco, California 94102. Office Hours: 8 a.m.-4:30 p.m.
Seattle Region--Alaska, Idaho, Oregon, Washington. 1321 Second
Avenue, Room 615, Mail Stop 211, Seattle, Washington 98101. Office
Hours 8 a.m.-4:30 p.m.
III. Intermediary Addresses (Hospital Insurance)
Medicare Coordinator, Assoc. Hospital Serv. Maine (ME BC), 2
Gannett Drive South, Portland, ME 04106-6911.
Medicare Coordinator, Anthem New Hampshire, 300 Goffs Falls Road,
Manchester, NH 03111-0001.
Medicare Coordinator, BC/BS Rhode Island (RI BC), 444 Westminster
Street, Providence, RI 02903-3279.
Medicare Coordinator, Empire Medicare Services, 400 S. Salina
Street, Syracuse, NY 13202.
Medicare Coordinator, Cooperativa, PO Box 363428, San Juan, PR
00936-3428.
Medicare Coordinator, Maryland B/C, PO Box 4368, 1946 Greenspring
Ave., Timonium, MD 21093.
Medicare Coordinator, Highmark, P5103, 120 Fifth Avenue Place,
Pittsburgh, PA 15222-3099.
Medicare Coordinator, United Government Services, 1515 N.
Rivercenter Dr., Milwaukee, WI 53212.
Medicare Coordinator, Alabama B/C, 450 Riverchase Parkway East,
Birmingham, AL 35298.
Medicare Coordinator, Florida B/C, 532 Riverside Ave.,
Jacksonville, FL 32202-4918.
Medicare Coordinator, Georgia B/C, PO Box 9048, 2357 Warm Springs
Road, Columbus, GA 31908.
Medicare Coordinator, Mississippi B/C B MS, PO Box 23035, 3545
Lakeland Drive, Jackson, MI 39225-3035.
Medicare Coordinator, North Carolina B/C, PO Box 2291, Durham, NC
27702-2291.
Medicare Coordinator, Palmetto GBA A/RHHI, 17 Technology Circle,
Columbia, SC 29203-0001.
Medicare Coordinator, Tennessee B/C, 801 Pine Street, Chattanooga,
TN 37402-2555.
Medicare Coordinator, Anthem Insurance Co. (Anthm IN), PO Box
50451, 8115 Knue Road, Indianapolis, IN 46250-1936.
Medicare Coordinator, Arkansas B/C, 601 Gaines Street, Little Rock,
AR 72203.
Medicare Coordinator, Group Health of Oklahoma, 1215 South Boulder,
Tulsa, OK 74119-2827.
Medicare Coordinator, Trailblazer, PO Box 660156, Dallas, TX 75266-
0156.
Medicare Coordinator, Cahaba GBA, Station 7, 636 Grand Avenue, Des
Moines, IA 50309-2551.
Medicare Coordinator, Kansas B/C, PO Box 239, 1133 Topeka Ave.,
Topeka, KS 66629-0001.
Medicare Coordinator, Nebraska B/C, PO Box 3248, Main PO Station,
Omaha, NE 68180-0001.
Medicare Coordinator, Mutual of Omaha, PO Box 1602, Omaha, NE
68101.
Medicare Coordinator, Montana B/C, PO Box 5017, Great Falls Div.,
Great Falls, MT 59403-5017.
Medicare Coordinator, Noridian, 4510 13th Avenue SW., Fargo, ND
58121-0001.
Medicare Coordinator, Utah B/C, PO Box 30270, 2455 Parleys Way,
Salt Lake City, UT 84130-0270.
Medicare Coordinator, Wyoming B/C, 4000 House Avenue, Cheyenne, WY
82003.
Medicare Coordinator, Arizona B/C, PO Box 37700, Phoenix, AZ 85069.
Medicare Coordinator, UGS, PO Box 70000, Van Nuys, CA 91470-0000.
Medicare Coordinator, Regents BC, PO Box 8110 M/S D-4A, Portland,
OR 97207-8110.
[[Page 77765]]
Medicare Coordinator, Premera BC, PO Box 2847, Seattle, WA 98111-
2847.
IV. Medicare Carriers
Medicare Coordinator, NHIC, 75 Sargent William Terry Drive,
Hingham, MA 02044.
Medicare Coordinator, B/S Rhode Island (RI BS), 444 Westminster
Street, Providence, RI 02903-2790.
Medicare Coordinator, Trailblazer Health Enterprises, Meriden Park,
538 Preston Ave., Meriden, CT 06450.
Medicare Coordinator, Upstate Medicare Division, 11 Lewis Road,
Binghamton, NY 13902.
Medicare Coordinator, Empire Medicare Services, 2651 Strang Blvd.,
Yorktown Heights, NY, 10598.
Medicare Coordinator, Empire Medicare Services, NJ, 300 East Park
Drive, Harrisburg, PA 17106.
Medicare Coordinator, Triple S, 1441 F.D., Roosvelt Ave.,
Guaynabo, PR 00968.
Medicare Coordinator, Group Health Inc., 4th Floor, 88 West End
Avenue, New York, NY 10023.
Medicare Coordinator, Highmark, PO Box 89065, 1800 Center Street,
Camp Hill, PA 17089-9065.
Medicare Coordinator, Trailblazers Part B, 11150 McCormick Drive,
Executive Plaza 3 Suite 200, Hunt Valley, MD 21031.
Medicare Coordinator, Trailblazer Health Enterprises, Virginia, PO
Box 26463, Richmond, VA 23261-6463. United Medicare Coordinator,
Tricenturion, 1 Tower Square, Hartford, CT 06183.
Medicare Coordinator, Alabama B/S, 450 Riverchase Parkway East,
Birmingham, AL 35298.
Medicare Coordinator, Cahaba GBA, 12052 Middleground Road, Suite A,
Savannah, GA 31419.
Medicare Coordinator, Florida B/S, 532 Riverside Ave, Jacksonville,
FL 32202-4918.
Medicare Coordinator, Administar Federal, 9901 Linnstation Road,
Louisville, KY 40223.
Medicare Coordinator, Palmetto GBA, 17 Technology Circle, Columbia,
SC 29203-0001.
Medicare Coordinator, CIGNA, 2 Vantage Way, Nashville, TN 37228.
Medicare Coordinator, Railroad Retirement Board, 2743 Perimeter
Parkway, Building 250, Augusta, GA 30999.
Medicare Coordinator, Cahaba GBA, Jackson Miss, PO Box 22545,
Jackson, MI 39225-2545.
Medicare Coordinator, Administar Federal (IN), 8115 Knue Road,
Indianapolis, IN 46250-1936.
Medicare Coordinator, Wisconsin Physicians Service, PO Box 8190,
Madison, WI 53708-8190.
Medicare Coordinator, Nationwide Mutual Insurance Co., PO Box
16788, 1 Nationwide Plaza, Columbus, OH 43216-6788.
Medicare Coordinator, Arkansas B/S, 601 Gaines Street, Little Rock,
AR 72203.
Medicare Coordinator, Arkansas-New Mexico, 601 Gaines Street,
Little Rock, AR 72203.
Medicare Coordinator, Palmetto GBA-DMERC, 17 Technology Circle,
Columbia, SC 29203-0001.
Medicare Coordinator, Trailblazer Health Enterprises, 901 South
Central Expressway, Richardson, TX 75080.
Medicare Coordinator, Nordian, 636 Grand Avenue, Des Moines, IA
50309-2551.
Medicare Coordinator, Kansas B/S, PO Box 239, 1133 Topeka Ave.,
Topeka, KS 66629-0001.
Medicare Coordinator, Kansas B/S-NE, PO Box 239, 1133 Topeka Ave.,
Topeka, KS 66629-0239.
Medicare Coordinator, Montana B/S, PO Box 4309, Helena, MT 59601.
Medicare Coordinator, Nordian, 4305 13th Avenue South, Fargo, ND
58103-3373.
Medicare Coordinator, Noridian BCBSND (C0), 730 N. Simms
100, Golden, CO 80401-4730.
Medicare Coordinator, Noridian BCBSND (WY), 4305 13th Avenue South,
Fargo, ND 58103-3373.
Medicare Coordinator, Utah B/S, PO Box 30270, 2455 Parleys Way,
Salt Lake City, UT 84130-0270.
Medicare Coordinator, Transamerica Occidental, PO Box 54905, Los
Angeles, CA 90054-4905.
Medicare Coordinator, NHIC-California, 450 W. East Avenue, Chico,
CA 95926.
Medicare Coordinator, Cigna, Suite 254, 3150 Lakeharbor, Boise, ID
83703.
Medicare Coordinator, Cigna, Suite 506, 2 Vantage Way, Nashville,
TN 37228.
V. Payment Safeguard Contractors
Medicare Coordinator, Aspen Systems Corporation, 2277 Research
Blvd., Rockville, MD 20850.
Medicare Coordinator, DynCorp Electronic Data Systems (EDS, 11710
Plaza America Drive 5400 Legacy Drive, Reston, VA 20190-6017.
Medicare Coordinator, Lifecare Management Partners Mutual of Omaha
Insurance Co. 6601 Little River Turnpike, Suite 300 Mutual of Omaha
Plaza, Omaha, NE 68175.
Medicare Coordinator, Reliance Safeguard Solutions, Inc., PO Box
30207 400 South Salina Street, 2890 East Cottonwood Pkwy. Syracuse, NY
13202.
Medicare Coordinator, Science Applications International, Inc.,
6565 Arlington Blvd., PO Box 100282, Falls Church, VA.
Medicare Coordinator, California Medical Review, Inc., Integriguard
Division Federal Sector Civil Group, One Sansome Street, San Francisco,
CA 94104-4448.
Medicare Coordinator, Computer Sciences Corporation, Suite 600 3120
Timanus Lane, Baltimore, MD 21244.
Medicare Coordinator, Electronic Data Systems (EDS), 11710 Plaza
America Drive 5400 Legacy Drive, Plano, TX 75204.
Medicare Coordinator, TriCenturion, L.L.C., PO Box 100282,
Columbia, SC 29202.
[FR Doc. E6-22139 Filed 12-26-06; 8:45 am]
BILLING CODE 4120-03-P