Privacy Act of 1974; Report of a New System of Records, 35997-36000 [E7-12677]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 72, Number 126 (Monday, July 2, 2007)]
[Notices]
[Pages 35997-36000]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-12677]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of a New System of Records

AGENCY: Department of Health and Human Services (HHS), Center for 
Medicare & Medicaid Services (CMS).

ACTION: Notice of a New System of Records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to establish a new system titled, ``Medicare 
Master Death Records File (MMDRF), System No. 09-70-0597.'' Under the 
provisions of Sections 1106 (42 U.S.C. 1306 and 205(r) (42 U.S.C. 
405(r) of the Social Security Act (the Act), the Social Security 
Administration (SSA) will provide to CMS the SSA Death Master File 
including unrestricted State death data. CMS will use this death data 
to: (1) Ensure that no future payments are made to any physician or 
individually enrolled practitioner and other individuals for whom CMS 
has a record of death, and (2) investigate and initiate an appropriate 
response where a deceased physician's billing number has been found to 
have been used as the basis for a request for payment for services 
allegedly rendered after the physician's date of death. Upon 
independent verification of the facts with respect to specific 
individuals, the results will be used to update CMS databases and may 
also be used to support payment recovery operations and or the work of 
law enforcement. We have provided additional background information 
about the new system in the ``Supplementary Information'' section 
below.
    The primary purpose of this system is to collect and maintain 
Social Security Administration death records for physicians, non-
physician practitioners and individuals associated with organizational 
providers and suppliers to ensure payments are not made for services 
rendered after confirmed date of death and to prevent and/or detect any 
fraud, waste and abuse. Information retrieved from this system may be 
disclosed to: (1) Support regulatory, reimbursement, and policy 
functions performed within the agency or by a contractor, consultant, 
CMS grantee; (2) assist another Federal or State agency with 
information to contribute to the accuracy of CMS's proper payment of 
Medicare benefits, enable such agency to administer a Federal health 
benefits program, or to enable such agency to fulfill a requirement of 
Federal statute or regulation that implements a health benefits program 
funded in whole or in part with Federal funds; (3) support litigation 
involving the agency; and (4) combat fraud, waste, and abuse in certain 
Federally-funded health benefits programs.

EFFECTIVE DATES: CMS filed a new system report with the Chair of the 
House Committee on Oversight and Government Reform, the Chair of the 
Senate Committee on Homeland Security and Governmental Affairs, and the 
Administrator, Office of Information and Regulatory Affairs, Office of 
Management and Budget (OMB) on June 25, 2007. To ensure that all 
parties have adequate time in which to comment, the new SOR, including 
routine uses, will become effective 40 days from the publication of the 
notice, or from the date it was submitted to OMB and the Congress, 
whichever is later, unless CMS receives comments that require 
alterations to this notice. Although the Privacy Act requires only that 
CMS provide an opportunity for interested persons to comment on the 
proposed routine uses, CMS invites comments on all portions of this 
notice.

ADDRESSES: The public should address comments to: CMS Privacy Officer, 
Division of Privacy Compliance, Enterprise Architecture and Strategy 
Group, Office of Information Services, CMS, Room N2-04-27, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850. Comments received 
will be available for review at this location, by appointment, during 
regular business hours, Monday through Friday from 9 a.m.--3 p.m., 
Eastern Time zone.

FOR FURTHER INFORMATION CONTACT: Allen Gillespie, Technical Advisor, 
Division of Provider/Supplier Enrollment, Program Integrity Group, 
Office of Financial Management, Mail Stop C3-24-01, Centers for 
Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 
21244-1849. He can be reached by telephone at 410-786-5996, or via e-
mail at allen.gillespie@cms.hhs.gov.

SUPPLEMENTARY INFORMATION: CMS staff will develop a program to compare 
data on the monthly MMDRF with individuals in the Provider Enrollment 
Chain Ownership System (PECOS). A report of potential matches from the 
MMDRF and PECOS will be distributed monthly to the Parts A and B MACs 
and affiliated contractors. CMS will issue manual instructions with 
procedures contractors should follow to determine if the individual 
name on the monthly report is a match to the individual in the

[[Page 35998]]

PECOS database. When contractors verify there is a match there will be 
additional procedures for updating PECOS and, in turn, the 
corresponding claims systems.

I. Description of the Proposed System of Records

A. Statutory and Regulatory Basis for SOR

    The statutory authority for maintenance of this system is given 
under the provisions of Sections 1106 (42 U.S.C. 1306) and 205(r) (42 
U.S.C. 405(r)) of the Social Security Act (the Act).

B. Collection and Maintenance of Data in the System Information is 
collected on all providers with a Social Security number (SSN) whose 
death has been reported to the Social Security Administration or to 
CMS, and the death has not been verified. The system will comprise 
death records about providers who participate in the Medicare program. 
Examples include, but are not limited to: name, SSN, demographic 
information, unique provider identification number, National Provider 
Identifier (NPI), etc.

II. Agency Policies, Procedures, and Restrictions on Routine Uses

    A. The Privacy Act permits us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected. Any such disclosure of data is known as a ``routine use.'' 
The Government will only release MMDRF information that can be 
associated with an individual as prt will only release MMDRF 
information that can be associated with an individual as provided for 
under ``Section III. Proposed Routine Use Disclosures of Data in the 
System.'' Both identifiable and non-identifiable data may be disclosed 
under a routine use. We will only collect the minimum personal data 
necessary to achieve the purpose of MMDRF.
    CMS has the following policies and procedures concerning 
disclosures of information that will be maintained in the system. 
Disclosure of information from the system will be approved only to the 
extent necessary to accomplish the purpose of the disclosure and only 
after CMS:
    1. Determines that the use or disclosure is consistent with the 
reason that the data is being collected; e.g., to collect and maintain 
Social Security Administration death records for physicians, non-
physician practitioners and individuals associated with organizational 
providers and suppliers to ensure payments are not made for services 
rendered after confirmed date of death and to prevent and/or detect any 
fraud, waste and abuse.
    2. Determines that:
    a. The purpose for which the disclosure is to be made can only be 
accomplished if the record is provided in individually identifiable 
form;
    b. The purpose for which the disclosure is to be made is of 
sufficient importance to warrant the effect and/or risk on the privacy 
of the individual that additional exposure of the record might bring; 
and
    c. There is a strong probability that the proposed use of the data 
would in fact accomplish the stated purpose(s).
    3. Requires the information recipient to:
    a. Establish administrative, technical, and physical safeguards to 
prevent unauthorized use of disclosure of the record;
    b. Remove or destroy, at the earliest time, all patient-
identifiable information; and
    c. Agree to not use or disclose the information for any purpose 
other than the stated purpose under which the information was 
disclosed.
    4. Determines that the data are valid and reliable.

III. Routine Uses of Data

    A. The Privacy Act allows us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected. Any such compatible use of data is known as a ``routine 
use.'' The proposed routine uses in this system meet the compatibility 
requirement of the Privacy Act. We are proposing to establish the 
following routine use disclosures of information maintained in the 
system:
    1. To agency contractors, consultants or grantees, who have been 
engaged by the agency to assist in the performance of a service related 
to this collection and who need to have access to the records in order 
to perform the activity.
    We contemplate disclosing information under this routine use only 
in situations in which CMS may enter into a contractual or similar 
agreement with a third party to assist in accomplishing CMS function 
relating to purposes for this system.
    CMS occasionally contracts out certain of its functions when doing 
so would contribute to effective and efficient operations. CMS must be 
able to give a contractor, consultant or grantee whatever information 
is necessary for the contractor or consultant to fulfill its duties. In 
these situations, safeguards are provided in the contract prohibiting 
the contractor, consultant or grantee from using or disclosing the 
information for any purpose other than that described in the contract 
and requires the contractor, consultant or grantee to return or destroy 
all information at the completion of the contract.
    2. To another Federal or State agency to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits;
    b. Enable such agency to administer a Federal health benefits 
program, or, as necessary, to enable such agency to fulfill a 
requirement of a Federal statute or regulation that implements a health 
benefits program funded in whole or in part with Federal funds; and/or
    c. Assist Federal/state Medicaid programs within the State.
    Other Federal or State agencies, in their administration of a 
Federal health program, may require MMDRF information in order to 
support evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper reimbursement for services provided.
    3. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof, or
    b. Any employee of the agency in his or her official capacity, or
    c. Any employee of the agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government, is a party to litigation or has an 
interest in such litigation, and, by careful review, CMS determines 
that the records are both relevant and necessary to the litigation and 
that the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    Whenever CMS is involved in litigation, and occasionally when 
another party is involved in litigation and CMS policies or operations 
could be affected by the outcome of the litigation, CMS would be able 
to disclose information to the DOJ, court or adjudicatory body 
involved.
    4. To a CMS contractor that assists in the administration of a CMS-
administered health benefits program, or to a grantee of a CMS-
administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct,

[[Page 35999]]

remedy, or otherwise combat fraud, waste, or abuse in such program.
    We contemplate disclosing information under this routine use only 
in situations in which CMS may enter into a contractual, grantee, 
cooperative agreement or consultant relationship with a third party to 
assist in accomplishing CMS functions relating to the purpose of 
combating fraud and abuse. CMS occasionally contracts out certain of 
its functions or makes grants or cooperative agreements when doing so 
would contribute to effective and efficient operations. CMS must be 
able to give a contractor, grantee, consultant or other legal agent 
whatever information is necessary for the agent to fulfill its duties. 
In these situations, safeguards are provided in the contract 
prohibiting the agent from using or disclosing the information for any 
purpose other than that described in the contract and requiring the 
agent to return or destroy all information.
    5. To another Federal agency or to an instrumentality of any 
governmental jurisdiction within or under the control of the United 
States (including any State or local governmental agency), that 
administers, or that has the authority to investigate potential fraud, 
waste, or abuse in, a health benefits program funded in whole or in 
part by Federal funds, when disclosure is deemed reasonably necessary 
by CMS to prevent, deter, discover, detect, investigate, examine, 
prosecute, sue with respect to, defend against, correct, remedy, or 
otherwise combat fraud, waste, or abuse in such programs.
    Other agencies may require MMDRF information for the purpose of 
combating fraud, waste, and abuse in such Federally-funded programs.

IV. Protections

    CMS has safeguards in place for authorized users and monitors such 
users to ensure against unauthorized use. Personnel having access to 
the system have been trained in the Privacy Act and information 
security requirements. Employees who maintain records in this system 
are instructed not to release data until the intended recipient agrees 
to implement appropriate management, operational and technical 
safeguards sufficient to protect the confidentiality, integrity and 
availability of the information and information systems and to prevent 
unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: The Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002; the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: All pertinent National 
Institute of Standards and Technology publications; the HHS Information 
Systems Program Handbook and the CMS Information Security Handbook.

V. Effects on Individual Rights

    CMS proposes to establish this system in accordance with the 
principles and requirements of the Privacy Act and will collect, use, 
and disseminate information only as prescribed therein. Data in this 
system will be subject to the authorized releases in accordance with 
the routine uses identified in this system of records.
    CMS will take precautionary measures to minimize the risks of 
unauthorized access to the records and the potential harm to individual 
privacy or other personal or property rights of patients whose data are 
maintained in this system. CMS will collect only that information 
necessary to perform the system's functions. In addition, CMS will make 
disclosure from the proposed system only with consent of the subject 
individual, or his/her legal representative, or in accordance with an 
applicable exception provision of the Privacy Act. CMS, therefore, does 
not anticipate an unfavorable effect on individual privacy as a result 
of information relating to individuals.

    Dated: June 20, 2007.
Charlene Frizzera,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NO. 09-70-0597

SYSTEM NAME:
    ``Medicare Master Death Records File (MMDRF),'' HHS/CMS/OFM.

SECURITY CLASSIFICATION:
    Level Three Privacy Act Sensitive Data.

SYSTEM LOCATION:
    Centers for Medicare & Medicaid Services (CMS) Data Center, 7500 
Security Boulevard, North Building, First Floor, Baltimore, Maryland 
21244-1850 and at various co-locations of CMS agents.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    Information is collected on all providers with a Social Security 
number (SSN) whose death has been reported to the Social Security 
Administration or to CMS, and the death has not been verified. The 
system will comprise death records about providers who participate in 
the Medicare program.

CATEGORIES OF RECORDS IN THE SYSTEM:
    The collected information will include, but is not limited to: 
name, SSN, demographic information, unique provider identification 
number, National Provider Identifier (NPI), etc.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    The statutory authority for maintenance of this system is given 
under the provisions of Sections 1106 (42 U.S.C. 1306) and 205(r) (42 
U.S.C. 405(r)) of the Social Security Act (the Act).

PURPOSE(S) OF THE SYSTEM:
    The primary purpose of this system is to collect and maintain 
Social Security Administration death records for physicians, non-
physician practitioners and individuals associated with organizational 
providers and suppliers to ensure payments are not made for services 
rendered after confirmed date of death and to prevent and/or detect any 
fraud, waste and abuse. Information retrieved from this system may be 
disclosed to: (1) Support regulatory, reimbursement, and policy 
functions performed within the agency or by a contractor, consultant, 
CMS grantee; (2) assist another Federal or State agency with 
information to contribute to the accuracy of CMS's proper payment of 
Medicare benefits, enable such agency to administer a Federal health 
benefits program, or to enable such agency to fulfill a requirement of 
Federal statute or regulation that implements a health benefits program 
funded in whole or in part with Federal funds; (3) support litigation 
involving the agency; and (4) combat fraud, waste, and abuse in certain 
Federally-funded health benefits programs.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OR USERS AND THE PURPOSES OF SUCH USES:
    A. The Privacy Act allows us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected.

[[Page 36000]]

Any such compatible use of data is known as a ``routine use.'' The 
proposed routine uses in this system meet the compatibility requirement 
of the Privacy Act. We are proposing to establish the following routine 
use disclosures of information maintained in the system:
    1. To agency contractors, consultants or grantees, who have been 
engaged by the agency to assist in the performance of a service related 
to this collection and who need to have access to the records in order 
to perform the activity.
    2. To another Federal or State agency to:
    a. Contribute to the accuracy of CMS's proper payment of Medicare 
benefits;
    b. Enable such agency to administer a Federal health benefits 
program, or, as necessary, to enable such agency to fulfill a 
requirement of a Federal statute or regulation that implements a health 
benefits program funded in whole or in part with Federal funds; and/or
    c. Assist Federal/state Medicaid programs within the state.
    3. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof, or
    b. Any employee of the agency in his or her official capacity, or
    c. Any employee of the agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government, is a party to litigation or has an 
interest in such litigation, and, by careful review, CMS determines 
that the records are both relevant and necessary to the litigation and 
that the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    4. To a CMS contractor that assists in the administration of a CMS-
administered health benefits program, or to a grantee of a CMS-
administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct, 
remedy, or otherwise combat fraud or abuse in such program.
    5. To another Federal agency or to an instrumentality of any 
governmental jurisdiction within or under the control of the United 
States (including any State or local governmental agency), that 
administers, or that has the authority to investigate potential fraud 
or abuse in, a health benefits program funded in whole or in part by 
Federal funds, when disclosure is deemed reasonably necessary by CMS to 
prevent, deter, discover, detect, investigate, examine, prosecute, sue 
with respect to, defend against, correct, remedy, or otherwise combat 
fraud or abuse in such programs.

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, 
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
    All records are stored on electronic media.

RETRIEVABILITY:
    The collected data are retrieved by the name or other identifying 
information of the physician/practitioner, health care provider.

PROTECTIONS:
    CMS has safeguards in place for authorized users and monitors such 
users to ensure against unauthorized use. Personnel having access to 
the system have been trained in the Privacy Act and information 
security requirements. Employees who maintain records in this system 
are instructed not to release data until the intended recipient agrees 
to implement appropriate management, operational and technical 
safeguards sufficient to protect the confidentiality, integrity and 
availability of the information and information systems and to prevent 
unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: the Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: all pertinent National 
Institute of Standards and Technology publications; the HHS Information 
Systems Program Handbook and the CMS Information Security Handbook.

RETENTION AND DISPOSAL:
    CMS will retain identifiable information maintained in the MMDRF 
system of records for a period of 6 years 3 months. All claims-related 
records are encompassed by the document preservation order and will be 
retained until notification is received from DOJ.

SYSTEM MANAGER AND ADDRESS:
    Director, Division of Provider/Supplier Enrollment, Program 
Integrity Group, Office of Financial Management, Mail Stop C3-24-01, 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, MD 21244-1849.

NOTIFICATION PROCEDURE:
    For purpose of access, the subject individual should write to the 
system manager who will require the system name, employee 
identification number, tax identification number, national provider 
number, and for verification purposes, the subject individual's name 
(woman's maiden name, if applicable), NPI, and/or SSN (furnishing the 
SSN is voluntary, but it may make searching for a record easier and 
prevent delay).

RECORD ACCESS PROCEDURE:
    For purpose of access, use the same procedures outlined in 
Notification Procedures above. Requestors should also reasonably 
specify the record contents being sought. (These procedures are in 
accordance with Department regulation 45 CFR 5b.5(a)(2)).

CONTESTING RECORD PROCEDURES:
    The subject individual should contact the system manager named 
above, and reasonably identify the record and specify the information 
to be contested. State the corrective action sought and the reasons for 
the correction with supporting justification. (These procedures are in 
accordance with Department regulation 45 CFR 5b.7).

RECORDS SOURCE CATEGORIES
    Data will be collected from beneficiary enrollment records, 
provider enrollment records, and the Death Master File including 
unrestricted State death data provided by the Social Security 
Administration.

SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT
    None.
[FR Doc. E7-12677 Filed 6-29-07; 8:45 am]
BILLING CODE 4120-03-P