Primary Source Data

We are often asked if we have the Medicare Exclusion Database (MED) in our system. We do not collect the MED directly from CMS, but we do have this data in our system. The reason for this is because we collect our data from the primary source, as the Office of Inspector General is the primary source, we do not see a need to collect this data from the CMS as well.

We are precise in our collection. We believe in quality over quantity here at Typhoon Data. We don’t see a need in collecting “Everything”. Instead, we collect the pertinent, actionable, and primary source records that can help you and your clients get a full and complete picture on your health care providers. We take pride in our knowledge of these sources.

Last week, we got official and final confirmation that collecting the MED is not necessary.

Exact verbiage from CMS in regards to the MED:

“The Medicare Exclusion Database (MED) is a national database populated with information from the Office of the Inspector General.”

Medicaid Fraud

The Medicaid Fraud Control Units report was just released. Here are a few highlights:

  1. 1,564 convictions (slightly up from 1,557 the year before).
  2. Almost $1.9 billion in recoveries. The total cost of recovery was “$259 million in State and Federal Funds” making it “an average of over $7 for every dollar spent.”
  3. The provider type with the most convictions was “PCS Attendant, PCS Agency, or other Home Care Aide” with 552.
    1. The next provider type was “Nurse (LPN, RN, or other licensed), PA, or NP) with 171.
    2. “Nurse Aid” came after that with 153.
    3. Followed by “Family Practice Physician” with 57.
    4. And coming in last was “Home Health Agency” with 48.  
  4. 74% of the convictions involved fraud, 26% involved abuse or neglect.
  5. Pharmaceutical manufacturers accounted for “almost half of the civil settlements and judgments.”
  6. There were 998 civil settlements/judgments, the highest number in the last five years.

That sums up the most interesting data from this year’s report. The one that stands out the most to me is that pharmaceutical manufacturers accounted for “almost half of the civil settlements and judgments.” The report provides some insight:

Pharmaceutical manufacturer settlements typically relate to the marketing of prescription drugs. An additional 70 settlements and judgments involved laboratories, 67 involved medical device manufacturers, and 57 involved retail and wholesale pharmacies.  

The context is helpful, especially knowing that most of the settlements/judgments were because of marketing related issues. As always, if you have specific questions about compliance, data availability, the nuances of a particular source, or the best place to find the data you’re looking for, please don’t hesitate to reach out to me directly at ddecker@typhoondata.com or to call me at 800-780-5901, Extension 103.