Probe finds problems with Medicare doctor ID registry

An investigation by the HHS Office of Inspector General found that UPIN information frequently contains inaccurate addresses for physicians and practices.

By Geri Aston, AMNews staff. Oct. 1, 2001.

Washington -- A government inspection has turned up inaccuracies in the physician identification number registry used by Medicare.

The Unique Physician/Practitioner Identification Number Registry contained inaccurate addresses for 28% of the physicians and practices selected for the study, according to the review by the Health and Human Services Office of Inspector General. The agency examined a sample of 642 claims for Medicare Part B outpatient mental health service payments involving 571 practitioners.

"Even the Medicare carriers did not have correct addresses for all of these providers," the OIG noted.

The office roughly estimated that Medicare paid about $35 million in 1998 for outpatient mental health services billed by practitioners with inaccurate UPIN mailing addresses.

To get a UPIN, a doctor or group practice must submit a Medicare enrollment application, including relevant addresses, to the appropriate carrier. Once the registry assigns a UPIN, the carrier is responsible for maintaining physician enrollment data and promptly notifying the registry of address and other changes.

The OIG recommended that the Centers for Medicare & Medicaid Services take steps to validate and update the UPIN Registry data.

Over the past 10 years, the office has issued several reports identifying problems with the completeness and accuracy of practitioner information in carrier files and the UPIN Registry, the report noted. Between 1991 and 1992, the OIG found that some carriers did not require physicians to provide billing addresses on enrollment applications. [...]