The Healthcare Integrity and Protection Data Bank
The U.S. Department of Health and Human Services has determined that annual losses arising from healthcare fraud range from 3 to 10 percent of all healthcare expenditures–between $30 billion and $100 billion based on estimated 1997 expenditures.
The Healthcare Integrity and Protection Data Bank (HIPDB) was created in an attempt to combat healthcare fraud. An offshoot of the Health Insurance Portability and Accountability Act of 1996, HIPDB identifies activity by healthcare providers, practitioners, and suppliers that may require investigation.
One of the pieces of data that HIPDB collects is information concerning final adverse actions that have been taken against healthcare providers, suppliers, or practitioners. Such information may or may not be indicative of fraudulent healthcare activity. Final adverse actions do not include settlements made with providers, practitioners, and suppliers in which no findings of liability have been made. They also do not include any actions taken with regard to malpractice claims.
The HIPDB requires government agencies and health plans to report:
What the Final Adverse Action Reports Must Contain
Reports of a final adverse action against a healthcare provider, practitioner, or supplier must include the following information:
Information concerning a final adverse action, which is reported under the HIPDB, can be disclosed, upon request, to the healthcare provider, supplier, or licensed practitioner who is the subject of the action. They can then dispute the accuracy of the information.
Access to the information contained in the HIPDB is available to federal and state governmental agencies and health plans. By law, HIPDB information concerning specific practitioners, providers, or suppliers can not be disclosed to members of the general public. However, persons or entities may request the disclosure of HIPDB information that does not identify any particular healthcare provider, licensed practitioner, supplier, or entity.
Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.
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