[Federal Register: December 28, 2006 (Volume 71, Number 249)]
[Notices]
[Page 78211-78212]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28de06-88]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers For Medicare & Medicaid Services
Privacy Act of 1974; CMS Computer Match No. 2006-06, HHS Computer
Match No. 0603
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of Computer Matching Program (CMP).
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SUMMARY: In accordance with the requirements of the Privacy Act of
1974, as amended, this notice announces the establishment of a CMP that
CMS plans to conduct with various Participating States. We have
provided information about the matching program in the ``Supplementary
Information'' section below. The Privacy Act provides an opportunity
for interested persons to comment on the matching program. We may defer
implementation of this matching program if we receive comments that
persuade us to defer implementation. See ``Effective Dates'' section
below for comment period.
DATES: Effective Dates: CMS filed a report of the CMP with the Chair of
the House Committee on Government Reform and Oversight, the Chair of
the Senate Committee on Homeland Security and Governmental Affairs, and
the Administrator, Office of Information and Regulatory Affairs, Office
of Management and Budget (OMB) on December 20, 2006. We will not
disclose any information under a matching agreement until 40 days after
filing a report to OMB and Congress or 30 days after publication in the
Federal Register, whichever is later. We may defer implementation of
this matching program if we receive comments that persuade us to defer
implementation.
ADDRESSES: The public should address comments to: CMS Privacy Officer,
Division of Privacy Compliance, Enterprise Architecture and Strategy
Group, Office of Information Services, CMS, Mail-stop 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 daylight time.
FOR FURTHER INFORMATION CONTACT: Lourdes Grindal Miller, 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 410-786-1022 and e-mail is
Lourdes.grindalmiller@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Description of the Matching Program
A. General
The Computer Matching and Privacy Protection Act of 1988 (Public
Law (Pub. L.) 100-503), amended the Privacy Act (5 U.S.C. 552a) by
describing the manner in which computer matching involving Federal
agencies could be performed and adding certain protections for
individuals applying for and receiving Federal benefits.
Section 7201 of the Omnibus Budget Reconciliation Act of 1990 (Pub.
L. 101-508) further amended the Privacy Act regarding protections for
such individuals. The Privacy Act, as amended, regulates the use of
computer matching by Federal agencies when records in a system of
records are matched with other Federal, state, or local government
records. It requires Federal agencies involved in computer matching
programs to:
1. Negotiate written agreements with the other agencies
participating in the matching programs;
2. Obtain the Data Integrity Board approval of the match
agreements;
3. Furnish detailed reports about matching programs to Congress and
OMB;
4. Notify applicants and beneficiaries that the records are subject
to matching; and,
5. Verify match findings before reducing, suspending, terminating,
or denying an individual's benefits or payments.
B. CMS Computer Matches Subject to the Privacy Act
CMS has taken action to ensure that all CMPs that this Agency
participates in comply with the requirements of the Privacy Act of
1974, as amended.
Dated: December 19, 2006.
John R. Dyer,
Chief Operating Officer, Centers for Medicare & Medicaid Service.
CMS Computer Match No. 2006-06
HHS Computer Match No. 0603
NAME:
``Computer Matching Agreement (CMA) Between the Centers for
Medicare & Medicaid Services (CMS) and Participating States for the
Disclosure of Medicare and Medicaid Information.''
SECURITY CLASSIFICATION:
Level Three Privacy Act Sensitive.
PARTICIPATING AGENCIES:
The Centers for Medicare & Medicaid Services (CMS).
All Participating States, the District of Columbia, and the
territories of Guam, Puerto Rico, American Samoa, and the Virgin
Islands.
AUTHORITY FOR CONDUCTING MATCHING PROGRAM:
This CMA is executed to comply with the Privacy Act of 1974 (Title
5 United States Code (U.S.C.) 552a), as amended, (as amended by Public
Law (Pub. L.) 100-503, the Computer Matching and Privacy Protection Act
(CMPPA) of 1988), the Office of Management and Budget (OMB) Circular A-
130, titled ``Management of Federal Information Resources'' at 65
Federal Register (FR) 77677 (December 12, 2000), 61 FR 6435 (February
20, 1996), and OMB guidelines pertaining to computer matching at 54 FR
25818 (June 19, 1989).
This Agreement provides for information matching fully consistent
with the authority of the Secretary of the Department of Health and
Human Services (HHS) (the Secretary). Sections 1816 and 1842 of the
Social Security Act (the Act) permits the Secretary to make audits of
the records of providers as necessary to insure that proper
[[Page 78212]]
payments are made, to assist in the application of safeguards against
unnecessary utilization of services furnished by providers of services
and other persons to individuals entitled to benefits, and to perform
other functions as are necessary (Pub. L. 108-173 section 911, amending
Title XVIII, section 1874A (42 U.S.C. 1395kk-1).
Section 1857 of the Act provides that the Secretary, or any person
or organization designated by the Secretary shall have the right to
``inspect or otherwise evaluate (i) the quality, appropriateness, and
timeliness of services performed under the contract'' (42 U.S.C. 1395w-
27(d)(2)(A)); and ``audit and inspect any books and records of [a
Medicare Advantage] organization that pertain to services performed or
determinations of amounts payable under the contract.'' (42 U.S.C.
1395w-27(d) (2) (B)).
Furthermore, Sec. 1874(b) of the Act authorizes the Secretary to
``contract with any person, agency, or institution to secure on a
reimbursable basis such special data, actuarial information, and other
information as may be necessary in the carrying out of his functions
under Subchapter XVIII.'' (42 U.S.C. 1395kk(b).)
Section 1893 of the Act establishes the Medicare Integrity Program,
under which the Secretary may contract with eligible entities to
conduct a variety of program safeguard activities, including fraud
review employing equipment and software technologies that surpass
existing capabilities (42 U.S.C. 1395ddd)). These entities are called
Program Safeguards Contractors (PSC) and Medicare Drug Integrity
Contractors (MEDIC).
Pursuant to the applicable state statutes and guidelines for the
Participating State charged with the administration of the Medicaid
program, disclosure of the Medicaid data pursuant to this Agreement is
for purposes directly connected with the administration of the Medicaid
program, in compliance with 42 CFR 431.300 through 431.307. Those
purposes include the detection, prosecution, and deterrence of fraud,
waste and abuse (FW&A) in the Medicaid program.
PURPOSE (S) OF THE MATCHING PROGRAM:
The purpose of this Agreement is to establish the conditions,
safeguards, and procedures under which CMS will conduct a computer
matching program with Participating States to study claims, billing,
and eligibility information to detect suspected instances of Medicare
and Medicaid FW&A. CMS and the Participating State will provide a CMS
contractor (hereinafter referred to as the ``Custodian'') with Medicare
and Medicaid records pertaining to eligibility, claims, and billing
which the Custodian will match in order to merge the information as
necessary to conduct the match. Utilizing fraud detection software, the
information will then be used to identify patterns of aberrant
practices and abnormal patterns requiring further investigation.
Aberrant practices and abnormal patterns identified in this matching
program that constitute FW&A will involve individuals who are
practitioners, providers and suppliers of services, Medicare
beneficiaries, Medicaid recipients, and other individuals whose
information may be maintained in the records.
CATEGORIES OF RECORDS AND INDIVIDUALS COVERED BY THE MATCH:
This computer matching program (CMP) will enhance the ability of
CMS and Participating States to detect FW&A by matching claims data,
eligibility, and practitioner, provider, and supplier enrollment
records of Medicare beneficiaries, practitioners, providers, and
suppliers in the Participating State against records of Medicaid
recipients, practitioners, providers, and suppliers in the
Participating State.
DESCRIPTION OF RECORDS TO BE USED IN THE MATCHING PROGRAM:
National Claims History (NCH), System No. 09-70-0005 was published
at 71 FR 67137 (November 20, 2006).
Medicare Multi-Carrier Claims System (MCS) (formerly published as
the Carrier Medicare Claims Record (CMCR)), System No. 09-70-0501 was
published at 71 FR 64968 (November 6, 2006).
Enrollment Database (EDB), System No. 09-70-0502 was published at
67 FR 3203 (January 23, 2002).
Fiscal Intermediary Shared System (FISS) (formerly published as the
Intermediary Medicare Claims Record (IMCR), System No. 09-70-0503 was
published at 71 FR 64961 (November 6, 2006).
Unique Physician/Provider Identification Number (UPIN), System No.
09-70-0525, was published at 71 FR 66535 (November 15, 2006).
Medicare Supplier Identification File (MSIF), System No. 09-70-0530
was published at 71 FR 70404 (December 4, 2006).
Provider Enrollment Chain and Ownership System (PECOS), System No.
09-70-0532 was published at 71 FR 60536 (October 13, 2006).
Medicare Beneficiary Database (MBD), System No. 09-70-0536 was
published at 71 FR 70396 (December 4, 2006).
Medicare Drug Data Processing System (DDPS), System No. 09-70-0553
was published at 70 FR 58436 (October 6, 2005).
Medicare Advantage Prescription Drug (MARx) System, System No. 09-
70-4001 was published at 70 FR 60530 (October 18, 2005).
The records files that will be made available for this matching
program by the Participating State include utilization, entitlement,
and provider records.
INCLUSIVE DATES OF THE MATCH:
The CMP shall become effective 40 days after the report of the
matching program is sent to OMB and Congress, or 30 days after
publication in the Federal Register, which ever is later. The matching
program will continue for 18 months from the effective date and may be
extended for an additional 12 months thereafter, if certain conditions
are met.
[FR Doc. E6-22253 Filed 12-27-06; 8:45 am]
BILLING CODE 4120-03-P