■为了应对大流行,国防卫生局(DHA)将其TRICARE民用提供商网络扩展了30.1%。在2022年,DHA年度报告指出,TRICARE的提供商目录只有80%的准确性。与医疗保险不同,DHA没有公开披露国家提供者身份(NPI)号码。因此,TRICARE的960万受益人缺乏验证其医生证书的手段。自2013年以来,卫生与公共服务部(HHS)监察长办公室(OIG)已将17,706名医生和其他提供者排除在联邦健康计划之外,原因是账单欺诈。疏忽,与毒品有关的定罪,和其他罪行。这些提供商及其NPI包含在OIG的排除个人和实体列表(LEIE)中。从被排除的提供者那里接受护理的患者面临着更高的住院和死亡风险。
■我们试图评估TRICARE在其转诊网站上针对犯罪数据库筛选医疗保健提供者姓名的程度。
■在2023年1月1日至31日之间,我们使用TRICAREWest\的提供商目录搜索了798邮政编码5英里半径内的所有提供商(每个州38个,每人≥10,000名居民,随机输入)。然后,我们复制并粘贴所有目录结果\'名字和姓氏,企业名称,地址,电话号码,传真号码,学位类型,实践专业,并将活动或关闭状态转换为CSV文件。我们将搜索结果与美国和各州的医疗和刑事不当行为数据库进行了交叉引用,包括OIG-LEIE和总务管理局(GSA)SAM.gov排除名单,HHS民权健康保险流通和责任法案办公室(HIPAA)违规报告,15个可用的州医疗补助排除列表(州),国际贸易管理局的综合筛选清单(CSL),3食品和药物管理局(FDA)禁止名单,联邦调查局(FBI)1月6日的联邦被告名单,和OIG-HHS逃犯名单(FUG)。
■我们的提供商搜索产生了111,619个原始结果;54个邮政编码不包含任何数据。删除72,156(64.65%)个重复条目后,关闭办公室,和非TRICARE西部地区,我们确定了39,463个活动提供程序名称。在此基线样本组中,所有排除和制裁数据库总共有2398个(6.08%)匹配,包括OIG-LEIE上的2197,2311在GSA-SAM.gov名单上,2在HIPAA列表中,州医疗补助排除名单上有54人,69在CSL上,FDA名单上的3个,联邦调查局名单上有53名,和10在FUG上。
TRICARE\的民用供应商名册值得执法部门进一步审查。遵循国家标准与技术研究所800,DHA可以减轻隐私,安全,通过实施内部威胁管理模型和安全清除威胁,大力执行《虚假索赔法》,和强制性安全风险评估。这些是作者的观点,不是国防部或美国政府。
UNASSIGNED: To address the pandemic, the Defense Health Agency (DHA) expanded its TRICARE civilian provider network by 30.1%. In 2022, the DHA Annual Report stated that TRICARE\'s provider directories were only 80% accurate. Unlike Medicare, the DHA does not publicly reveal National Provider Identification (NPI) numbers. As a result, TRICARE\'s 9.6 million beneficiaries lack the means to verify their doctor\'s credentials. Since 2013, the Department of Health and Human Services\' (HHS) Office of Inspector General (OIG) has excluded 17,706 physicians and other providers from federal health programs due to billing fraud, neglect, drug-related convictions, and other offenses. These providers and their NPIs are included on the OIG\'s List of Excluded Individuals and Entities (LEIE). Patients who receive care from excluded providers face higher risks of hospitalization and mortality.
UNASSIGNED: We sought to assess the extent to which TRICARE screens health care provider names on their referral website against criminal databases.
UNASSIGNED: Between January 1-31, 2023, we used TRICARE West\'s provider directory to search for all providers within a 5-mile radius of 798 zip codes (38 per state, ≥10,000 residents each, randomly entered). We then copied and pasted all directory results\' first and last names, business names, addresses, phone numbers, fax numbers, degree types, practice specialties, and active or closed statuses into a CSV file. We cross-referenced the search results against US and state databases for medical and criminal
misconduct, including the OIG-LEIE and General Services Administration\'s (GSA) SAM.gov exclusion lists, the HHS Office of Civil Rights Health Insurance Portability and Accountability Act (HIPAA) breach reports, 15 available state Medicaid exclusion lists (state), the International Trade Administration\'s Consolidated Screening List (CSL), 3 Food and Drug Administration (FDA) debarment lists, the Federal Bureau of Investigation\'s (FBI) list of January 6 federal defendants, and the OIG-HHS list of fugitives (FUG).
UNASSIGNED: Our provider search yielded 111,619 raw results; 54 zip codes contained no data. After removing 72,156 (64.65%) duplicate entries, closed offices, and non-TRICARE West locations, we identified 39,463 active provider names. Within this baseline sample group, there were 2398 (6.08%) total matches against all exclusion and sanction databases, including 2197 on the OIG-LEIE, 2311 on the GSA-SAM.gov list, 2 on the HIPAA list, 54 on the state Medicaid exclusion lists, 69 on the CSL, 3 on the FDA lists, 53 on the FBI list, and 10 on the FUG.
UNASSIGNED: TRICARE\'s civilian provider roster merits further scrutiny by law enforcement. Following the National Institute of Standards and Technology 800, the DHA can mitigate privacy, safety, and security clearance threats by implementing an insider threat management model, robust enforcement of the False Claims Act, and mandatory security risk assessments. These are the views of the author, not the Department of Defense or the US government.