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.