Notice2024-11351
Privacy Act of 1974; Matching Program
Primary source
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Published
May 23, 2024
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
In accordance with subsection (e)(12) of the Privacy Act of 1974, as amended, the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) is providing notice of the establishment of a matching program between CMS and the Department of Veterans Affairs (VA), Veterans Health Administration (VHA) for "Identification and Recovery of Duplicate Payments for Medical Claims."
Full Text
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<title>Federal Register, Volume 89 Issue 101 (Thursday, May 23, 2024)</title>
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[Federal Register Volume 89, Number 101 (Thursday, May 23, 2024)]
[Notices]
[Pages 45661-45662]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-11351]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
Privacy Act of 1974; Matching Program
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS)
ACTION: Notice of a new matching program.
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SUMMARY: In accordance with subsection (e)(12) of the Privacy Act of
1974, as amended, the Department of Health and Human Services (HHS),
Centers for Medicare & Medicaid Services (CMS) is providing notice of
the establishment of a matching program between CMS and the Department
of Veterans Affairs (VA), Veterans Health Administration (VHA) for
``Identification and Recovery of Duplicate Payments for Medical
Claims.''
DATES: The deadline for comments on this notice is June 24, 2024. The
new matching program will commence not sooner than 30 days after
publication of this notice, provided no comments are received that
warrant a change to this notice. The matching program will be conducted
for an initial term of 18 months (from approximately June 24, 2024 to
December 23, 2025) and within 3 months of expiration may be renewed for
one additional year if the parties make no change to the matching
program and certify that the program has been conducted in compliance
with the matching agreement.
ADDRESSES: Interested parties may submit written comments on the new
matching program to the CMS Privacy Act Officer by mail at: Division of
Security, Privacy Policy & Governance, Information Security & Privacy
Group, Office of Information Technology, Centers for Medicare &
Medicaid Services, Location: N1-14-56, 7500 Security Blvd., Baltimore,
MD 21244-1850, or by email at <a href="/cdn-cgi/l/email-protection#9bd9fae9f9fae9fab5dffef6f4ebeef7f4e8dbf8f6e8b5f3f3e8b5fcf4ed"><span class="__cf_email__" data-cfemail="36745744545744571872535b5946435a594576555b45185e5e4518515940">[email protected]</span></a>.
FOR FURTHER INFORMATION CONTACT: If you have questions about the
matching program, you may contact Richard Mazur, CMS Technical Adviser,
Division of Medicare Secondary Payer Operations, Financial Services
Group, Office of Financial Management, Centers for Medicare & Medicaid
Services, at 410-786-1418, by email at <a href="/cdn-cgi/l/email-protection#03716a606b6271672d6e627976713143606e702d6b6b702d646c75"><span class="__cf_email__" data-cfemail="45372c262d2437216b28243f303777052628366b2d2d366b222a33">[email protected]</span></a>, or
by mail at 7500 Security Blvd., Baltimore, MD 21244.
SUPPLEMENTARY INFORMATION: The Privacy Act of 1974, as amended (5
U.S.C. 552a) provides certain protections for individuals applying for
and receiving federal benefits. The law governs the use of computer
matching by federal agencies when records in a system of records
(meaning, federal agency records about individuals retrieved by name or
other personal identifier) are matched with records of other federal or
non-federal agencies. The Privacy Act requires agencies involved in a
matching program to:
1. Enter into a written agreement, which must be prepared in
accordance with the Privacy Act, approved by the Data Integrity Board
(DIB) of each source and recipient federal agency, provided to Congress
and the Office of Management and Budget (OMB), and made available to
the public, as required by 5 U.S.C. 552a(o), (u)(3)(A), and (u)(4).
2. Notify the individuals whose information will be used in the
matching program that the information they provide is subject to
verification through matching, as required by 5 U.S.C. 552a(o)(1)(D).
3. Verify match findings before suspending, terminating, reducing,
or making a final denial of an individual's benefits or payments or
taking other adverse action against the individual, as required by 5
U.S.C. 552a(p).
4. Report the matching program to Congress and the OMB, in advance
and annually, as required by 5 U.S.C. 552a(o) (2)(A)(i), (r), and
(u)(3)(D).
5. Publish advance notice of the matching program in the Federal
Register as required by 5 U.S.C. 552a(e)(12).
This matching program meets these requirements.
Barbara Demopulos,
Privacy Act Officer, Division of Security, Privacy Policy and
Governance, Office of Information Technology, Centers for Medicare &
Medicaid Services.
Participating Agencies
The Department of Health and Human Services (HHS), Centers for
Medicare & Medicaid Services (CMS) is the recipient agency, and the
Department of Veterans Affairs (VA), Veterans Health Administration
(VHA) is the source agency.
Authority for Conducting the Matching Program
The authority for the matching program is 42 U.S.C. 1320a-7k and
1395 et seq.; and 38 U.S.C. 1703 and 1725.
Purpose(s)
The purpose of the matching program is to identify dual enrolled
beneficiaries and duplicate claims for the benefit of both CMS and VHA.
The matching program will assist both agencies in identifying those VHA
enrolled beneficiaries who are also enrolled as Medicare beneficiaries,
the specific claims where VHA and CMS made duplicate payments for the
same health care services, and potential fraud, waste, and abuse. The
claims for which both agencies made payment for the same service(s)
will be reviewed by both agencies, and recoupment action will be
initiated against the providers as appropriate.
Although Privacy Act records about beneficiaries will be used to
conduct the matches, the match results will be used to take actions
affecting only providers and suppliers. Some providers and suppliers
are solo practitioners (individuals), but they are not Privacy Act-
covered individuals in this matching program, because the claims
payment records to be used in this matching program are retrieved by
beneficiary identifiers only.
Categories of Individuals
The categories of individuals whose information will be used in the
matching program are: (1) Veterans enrolled in VHA healthcare, and (2)
Medicare enrolled beneficiaries (Part A and B) identified as dual
enrolled beneficiaries.
Categories of Records
The categories of records which will be used in the matching
program are VHA beneficiary identifying information and Medicare
beneficiary identifying information.
VHA Finder Files will include the following data elements about VHA
beneficiaries:
a. Transaction type: Add or Update
b. SSN
c. Medicare Claim Number (if available)
d. Date of Birth
e. Beneficiary First Name
f. Beneficiary Last Name
g. Beneficiary Sex
h. Enrollment Category (Enrolled or Not Enrolled)
i. Enrollment Status
j. Enrollment time frames: effective date and/or, when applicable, end
date
k. Date of Death (if applicable)
CMS Response Files will include the following data elements about
Medicare beneficiaries identified as dual enrolled:
a. Action type: Add/Update/Delete Record
b. SSN
c. MBI
d. Date of Birth
e. Beneficiary First Name
f. Beneficiary Last Name
g. Beneficiary Sex code
[[Page 45662]]
h. Medicare Enrollment time frames: Effective and termination dates
i. Medicare and VHA Dual enrollment timeframes: Effective and
termination dates
j. Date of death
System(s) of Records
The records used in the matching program will be disclosed from the
following systems of records, as authorized by routine uses published
in the system of records notices (SORNs) cited below:
A. Systems of Records Maintained by CMS
1. Common Working File (CWF), System No. 09-70-0526, last published
in full at 71 FR 64955 (Nov. 6, 2006), and partially updated at 78 FR
23938 (Apr. 23, 2013), 78 FR 32257 (May 29, 2013), and 83 FR 6591 (Feb.
14, 2018). Routine uses 2a and 10 authorize disclosures to VHA to
contribute to the accuracy of CMS' proper payment of Medicare benefits,
and to investigate potential fraud, waste, or abuse.
2. Medicare Beneficiary Database (MBD), System No. 09-70-0536, last
published in full at 71 FR 70396 (Dec. 4, 2006), and partially updated
at 78 FR 23938 (Apr. 23, 2013), 78 FR 32257 (May 29, 2013), and 83 FR
6591 (Feb. 14, 2018). Routine uses 2a and 11 authorize disclosures to
VHA to contribute to the accuracy of CMS's proper payment of Medicare
benefits, and to investigate potential fraud, waste, or abuse.
3. Medicare Integrated Data Repository (IDR), System No. 09-70-
0571, last published in full at 71 FR 74915 (Dec. 13, 2006), and
partially updated 76 FR 65196 (Oct. 20, 2011), 78 FR 23938 (Apr. 23,
2013), 78 FR 32257 (May 29, 2013), and 83 FR 6591 (Feb. 14, 2019).
Routine uses 2a and 11 authorize disclosures to VHA to contribute to
the accuracy of CMS's proper payment of Medicare benefits, and to
investigate potential fraud, waste, or abuse.
4. National Claims History (NCH), System No. 09-70-0558, last
published in full at 71 FR 67137 (Nov. 20, 2006), and partially updated
at 76 FR 65196 (Oct 20, 2011), 78 FR 23938 (Apr. 23, 2013), 78 FR 32257
(May 29, 2013), and 83 FR 6591 (Feb. 14, 2018). Routine uses 2a and 10
authorize disclosure to VHA to contribute to the accuracy of CMS's
proper payment of Medicare benefits, and to investigate potential
fraud, waste, or abuse.
B. Systems of Records Maintained by VHA
1. SOR 147VA10, entitled ``Enrollment and Eligibility Record-VA,''
last published at 86 FR 46090 (Aug. 17, 2021). Routine use 12
authorizes disclosures to federal agencies for purposes of preventing
and detecting possible fraud or abuse by individuals in their
operations and programs.
2. SOR 23VA10NB3, entitled ``Non-VA Care (Fee) Records,'' last
published at 80 FR 45590 (July 30, 2015). Routine use 12 authorizes
disclosures to CMS for its use in identifying potential duplicate
payments for healthcare services paid by VA and CMS. Routine use 30
authorizes disclosure to assist in preventing and detecting possible
fraud or abuse by individuals in federal programs.
[FR Doc. 2024-11351 Filed 5-22-24; 8:45 am]
BILLING CODE 4120-03-P
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