Discrepancies Found With National Provider IDs in CMS Database

July 7, 2015 in News

Tens of thousands of entries in a federal database intended to help patients research health care providers are significantly flawed, according to an investigation conducted by the Cincinnati Enquirer.

Background on Investigation

According to the investigation, the discrepancies are largely due to mistakes related to providers’ National Provider Identifier numbers (Hunt, Cincinnati Enquirer, 7/3).

An NPI is a 10-digit identification number that is required for use in all HIPAA-eligible transactions (iHealthBeat, 5/23/12). Patients can use providers’ NPIs to search CMS’ Physician Compare database, which also contains providers’ state license numbers.

David Marsidi — founder of EZDoctor, a company that compiles data on physicians and makes the information accessible for patients — discovered the discrepancies after a customer reported the company had supplied incorrect information about a physician. Marsidi said, “We went to the listing and tried to figure out what happened. We had been trusting the NPIs with some degree of accuracy, but we noticed that a lot of them weren’t linking to the correct physicians’ ID numbers.”

Marsidi then alerted the Cincinnati Enquirer of the issue, which corroborated the findings.

Details of Discrepancies

According to the investigation, the license numbers are incorrect for tens of thousands of providers in the system.

While some of the numbers are off by just one digit, others are completely incorrect. Investigators noted that the issues could be the result of typing errors or efforts to distance physicians from “sketchy pasts.” For example, the investigation found:

  • 35,000 NPI discrepancies in New York, some of which seemed to be intentionally fabricated because they contained non-numeric entries — such as “X” or “#” — instead of digits;
  • About 187 discrepancies in Ohio, including one discrepancy for a physician who has been sued six times over the past 16 years; and
  • An instance in Florida in which one physician’s NPI was used for about 30 different providers.

Many data experts and some former CMS employees said they were unaware of the discrepancies until they were highlighted by the Enquirer investigation.

CMS’ Reaction

CMS officials said they were not aware of any instances in which physicians intentionally supplied incorrect license numbers to the agency with the intent of misleading patients. In addition, CMS said it began checking the number of providers’ applications last year for new, changed or reactivated NPIs.

CMS said physicians might seek changes to their NPIs if they:

  • Change their specialties;
  • Receive a temporary license or permit that is later replace with a permanent one; or
  • Relocate to another state.

According to the Enquirer, CMS did not say whether it would address the various discrepancies highlighted in the investigation (Cincinnati Enquirer, 7/3).

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