Privacy Act of 1974; Matching Program, 81616-81617 [2024-23225]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 89, Number 195 (Tuesday, October 8, 2024)]
[Notices]
[Pages 81616-81617]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-23225]


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DEPARTMENT OF VETERANS AFFAIRS


Privacy Act of 1974; Matching Program

AGENCY: Department of Veterans Affairs (VA).

ACTION: Notice of a new matching program.

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SUMMARY: In accordance with the Privacy Act of 1974, as amended, VA is 
providing notice of a new matching program between VA and the 
Department of Health and Human Services (HHS) Centers for Medicare & 
Medicaid Services (CMS) entitled ``Disclosure of Information to Support 
the Veterans Affairs' ``Seek to Prevent Fraud, Waste, and Abuse 
Initiative.''

DATES: Comments on this matching program must be received no later than 
November 7, 2024. If no public comment is received during the period 
allowed for comment or unless otherwise published in the Federal 
Register by VA, the new agreement will become effective a minimum of 30 
days after date of publication in the Federal Register. If VA receives 
public comments, VA shall review the comments to determine whether any 
changes to the notice are necessary. This matching program will be 
valid for 18 months from the effective date of this notice.

ADDRESSES: Comments may be submitted through www.Regulations.gov or 
mailed to VA Privacy Service, 810 Vermont Avenue NW, (005X6F), 
Washington, DC 20420. Comments should indicate that they are submitted 
in response to ``Disclosure of Information to Support the Veteran 
Affairs' Seek to Prevent Fraud, Waste, and Abuse Initiative.'' Comments 
received will be available at regulations.gov for public viewing, 
inspection, or copies.

FOR FURTHER INFORMATION CONTACT: Elizabeth Morales, Director, VA Office 
of Business Oversight Program Integrity Office, 1615 Woodward Street, 
Austin, TX 78772, (512) 673-8960.

SUPPLEMENTARY INFORMATION: This Agreement establishes the terms, 
conditions, and procedures under which CMS will provide certain data to 
VA that supports the VA's Seek to Prevent Fraud, Waste, and Abuse 
initiative. The data will be provided from CMS' database of enrolled 
Medicare providers and suppliers (System of Records Notice [SORN] No. 
09-70-0532, Provider Enrollment, Chain, and Ownership System [PECOS]). 
Using PECOS data in a matching program for this purpose will provide VA 
prompt access to extant information, using an efficient process that 
both eliminates the need to manually compare substantial numbers of 
data-intensive files and enables VA to leverage, instead of 
duplicating, the costly Advance Provider Screening process that CMS 
uses to check suitability of Medicare providers and generate the data 
in PECOS.
    Participating Agencies: VA and CMS.
    Authority for Conducting the Matching Program: This Agreement is 
executed pursuant to the Privacy Act (5 United Stated Code [U.S.C.] 
552a) and the regulations and guidance promulgated thereunder; Office 
of Management and Budget (OMB) Circular A-108, Federal Agency 
Responsibilities for Review, Reporting, and Publication under the 
Privacy Act, published at 81 Federal Register (FR) 94424 (December 23, 
2016); and OMB guidelines pertaining to computer matching published at 
54 FR 25818 (June 19, 1989). Title 38 U.S.C. 7301(b) states that the 
primary function of VA is to provide a complete medical and hospital 
service for the care of eligible Veterans. In carrying out this 
function, including through contracts with external entities and 
providers, VA has an obligation to (1) ensure providers furnish care 
that is appropriate and safe and meets or exceeds professional 
standards for quality and (2), in the case of external providers, 
maintain billing integrity and compliance with contractual terms.
    Purpose(s): Under this matching program, VA internal and external 
providers will be matched against the database of Medicare providers 
and suppliers who have been revoked by CMS pursuant to 42 Code of 
Federal Regulations (CFR) section 424.535. VA intends to review the 
information provided, perform additional validation, and if deemed 
appropriate, conduct further investigation, or refer the matter to the 
VA Office of the Inspector General (OIG) for further investigation. 
Based on additional validation or investigation, should VA determine VA 
program requirements have been violated, VA intends to take action (or 
refer to the OIG for action) against the VA internal and external 
providers. Such action may be based on activities that endanger VA 
patients and/or reflect improper or erroneous billing practices related 
to claims for health care provided to VA beneficiaries. Actions VA may 
take include (1) terminating or modifying existing contractual or 
provider agreements; (2) stopping referral of VA patients to the VA 
external providers; (3) referring the VA internal and external 
providers to the

[[Page 81617]]

OIG; (4) performing pre- or post-payment reviews of claims paid or 
submitted; or (5) taking disciplinary actions or removing, demoting, or 
suspending VA internal providers.
    Categories of Individuals: VA internal and external health care 
providers will be matched against the database of Medicare providers 
who have been revoked by CMS under 42 CFR 424.535. ``Provider'' is 
defined by 42 CFR 400.202 as a ``hospital, a Critical Access Hospital, 
a skilled nursing facility, a comprehensive outpatient rehabilitation 
facility, a home health agency, or a hospice that has in effect an 
agreement to participate in Medicare, or a clinic, a rehabilitation 
agency, or a public health agency that has in effect a similar 
agreement but only to furnish outpatient physical therapy or speech 
pathology services, or a community mental health center that has in 
effect a similar agreement but only to furnish partial hospitalization 
services.''
    Categories of Records: VA will provide CMS electronic files, in a 
format defined by CMS, containing identifying information required to 
match VA records with CMS records. Data fields will include one or more 
of the following elements: (1) Name of Provider/Business; (2) Tax 
Identification Number (TIN) (EIN, ITIN or SSN); (3) National Provider 
Identifier (NPI); (4) State(s) in which the provider is providing 
services; and (5) Specialty Code or Taxonomy Code. Upon matching the 
TIN or NPI, CMS will provide VA the matched data elements above and the 
following additional fields: (1) NPI (for individuals) where VA 
provided a TIN; (2) Current Enrollment Status; (3) Current Enrollment 
Status Effective Date; (4) Status Reason (PECOS codes used to denote 
the specific reason(s) on which the final revocation was based); and 
(5) All NPIs associated with a revoked TIN to include all above fields 
(1-4) and Enrollment State, Specialty, Role, Enrollment Bar status, and 
Enrollment Bar Expiration Date (if applicable).
    System(s) of Records: VA will provide information covered by SOR 
77VA10E2E, Health Care Provider Credentialing and Privileging Records-
VA, last published in full at 85 FR 7395 (February 7, 2020), routine 
uses 1 and 2; SOR 23VA10NB3, Non-VA Care (Fee) Records-VA, last 
published in full at 80 FR 45590 (July 30, 2015), routine use 2 and 30; 
SOR 02VA135, Applicants for Employment under Title 38, U.S.C.-VA, last 
published in full at 42 FR 49728 (September 27, 1977), and updated at 
51 FR 25969 (July 17, 1986), 55 FR 42534 (October 19, 1990), and 58 FR 
40852 (July 30, 1993), see routine uses 1 and 2 published at 42 FR 
49728; and SOR 186VA10D, entitled ``Community Care Provider Profile 
Management System,'' last published in full at 86 FR 6979 (January 25, 
2021). See routine use 10. CMS will provide information covered by 
Provider Enrollment Chain and Ownership System (PECOS), System No. 09-
70-0532, last published in full at 71 FR 60536 (Oct. 13, 2006) and 
updated at 78 FR 32257 (May 29, 2013) and 83 FR 6591 (Feb. 14, 2018), 
see routine use 6 published at 71 FR 60536 and the unnumbered routine 
use published at 78 FR 32257; and National Plan and Provider 
Enumeration System (NPPES), System No. 09-70-0555, last published in 
full at 75 FR 30411 (June 1, 2010) and updated at 78 FR 32257 (May 29, 
2013) and 83 FR 6591 (Feb. 14, 2018), see routine use 5 published at 75 
FR 30411 and the unnumbered routine use published at 78 FR 32257.

Signing Authority

    The Senior Agency Official for Privacy, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. John 
Oswalt, Chief Privacy Officer and Chair of the Data Integrity Board, 
Department of Veterans Affairs approved this document on August 27, 
2024 for publication.

    Dated: October 3, 2024.
Amy L. Rose,
Government Information Specialist, VA Privacy Service, Office of 
Compliance, Risk and Remediation, Office of Information and Technology, 
Department of Veterans Affairs.
[FR Doc. 2024-23225 Filed 10-7-24; 8:45 am]
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