Invalid NPIs Cost Medicare Millions in 2007

The National Provider Identifier (NPI), requested on all claims submitted to Medicare since May 2007 and required since May 2008, is a Health Insurance Portability and Accountability Act (HIPAA) mandate intended to simplify administration. According to an Office of Inspector General (OIG) report, however, Medicare has allowed the NPI requirement to be one more way to lose money.

According to the report, Medicare allowed approximately $34 million in 2007 for medical equipment and supply claims with physician identification numbers that had never been issued or had been deactivated by the Centers for Medicare & Medicaid Services (CMS). About $5 million of that was for claims with dates of service after the physicians identified on the claims died.

The report goes on to say that Medicare allowed over $6 million in 2007 for claims with invalid referring physician unique physician identification numbers (UPINs) that had never been issued by CMS. Also in 2007, Medicare allowed approximately $28 million for claims with referring physician UPINs that CMS had deactivated, including $5 million for claims with a date of service after the physicians identified on the claims had died, and over $300,000 for claims with invalid referring physician NPIs.

CMS concurred with the OIG report, stating they will look into why these improper payments were allowed and implement claims-processing system changes.

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14 Responses to “Invalid NPIs Cost Medicare Millions in 2007”

  1. Cathy says:

    Typical of the CMS inefficiency…………….

  2. Cindi says:

    Didn’t the physicians have to apply for the NPI? Or were they just automatically issued?

  3. Janet says:

    All physicians had to apply for the NPI numbers and then they were issued; therefore, I do not know how they paid claims for numbers that were not issued or applied for.

  4. Karen says:

    and we want the government taking over our health care??? wow.

  5. Cathy W says:

    I too am amazed that any claim got paid by Medicare without being squeeky clean. Even with complying with CMS’ rules we have to fight for payment sometimes. This brings me to the thought that changing to ICD-10 is going to be required, at great expense, by all providers but will CMS really be ready? I doubt it!

  6. Yolanda says:

    Our providers all have active NPI numbers, and we get denials for our NPI all too often. I just don’t understand how this mistake was ever allowed to happen! What a system!!!!!

  7. JoAnne S says:

    Perhaps this npi issue has to do with Medicare losing 75% of provider legacy and npi numbers on their database with the implementation of the npi. There was a system crash- not sure what states were involved but I know New England was affected. Providers had to call Medicare to reinstate their numbers by telephone or on paper because claims were denying for “Not a Medicare Provider”.
    As far as I can tell, no communication about this crash was given, but I could be wrong. I heard it directly from 2 Medicare reps who helped me because my ALL billing company clients lost their numbers!!
    Typically you must put in writing a request to Medicare for confirmation of numbers, etc…but not when the system crashed. They took info over the telephone.
    I bet that is why there are so many problems.

  8. judi says:

    It seems they should have something in their system that automatically throws out invalid numbers…like they automatically throw out any of our claims with a . out of place!

  9. Kevin Richmond says:

    It’s really going to be a tough time for CMS & providers when ICD-10 implemented. Isn’t it

  10. Susan says:

    The reason why this happened is because the claims processing departments hire people & do not train them, so you have people who do not know what the are doing or how to do it.

  11. Sherry says:

    Well I always knew NPI would be another goverment mess. It has done nothing but create problems and cost all of us more money. Outside of CMS we still have to use specific insurance issued ID#’s to get claims status. What a mess and they accuse us of fraud?????

  12. D.Garner says:

    To think this is the government agency that some of us in ten or fifteen will depend upon to take care of our health care issues. I never did understand why the physicians needed an NPI since they were already credentialed and all had UPINs.

  13. Barbara says:

    Can we assume the folks sending in claims for providers who are dead should have known that? Can we also assume the folks making up random numbers to mee the NPI digits requirements knew they were doing it? Another case of fraud and abuse and guess who is paying for all of this? Right.

  14. Susan Luedtke says:

    NPI’s – What will they think of next? With all the problems brought about concerning the NPI’s I hate to even think what will happen when EMR is required. Those of us that are trying to get all of our ducks in a row and make things as efficient as possible will probably not have everything just perfect and cost alot of money to get it right. Maybe that is why physicians take their good ol time getting on government mandates – It always costs more money than first thought because government never has a program that is error free.

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