[Federal Register Volume 67, Number 38 (Tuesday, February 26, 2002)]
[Notices]
[Pages 8810-8815]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-4469]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services


Privacy Act of 1974; Report of New System

AGENCY: Department of Health and Human Services (HHS), Centers for 
Medicare & Medicaid Services (CMS) (formerly the Health Care Financing 
Administration).

ACTION: Notice of 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 of records, called the 
``Medicare Exclusion Database (MED),'' HHS/CMS/OFM/ No. 09-70-0534. The 
primary purpose of this system of records is to retrieve information 
that will be used to aid in the ability of CMS and its contractors 
(private insurance companies contracted to receive, check and pay bills 
submitted by providers of services) to ensure that no Medicare payments 
are made with respect to any item or service (other than an emergency 
item or service) furnished by an individual or entity during the period 
when such individual or entity is excluded from participation in 
Medicare. The information retrieved from this system of records will be 
used to support regulatory, reimbursement, and policy functions 
performed within the agency or by a contractor or consultant; to 
another Federal or State agency to contribute to the accuracy of CMS' 
proper payment of Medicare benefits, to enable such agency to 
administer a Federal health benefits program, or 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; support constituent requests made to a Congressional 
representative; support litigation involving the agency; and support 
research, evaluation, and for payment related projects; and to disclose 
individual-specific information for the purpose of combating fraud and 
abuse in health benefits programs administered by CMS.
    We have provided background information about the proposed system 
in the SUPPLEMENTARY INFORMATION section below. Although the Privacy 
Act requires only that the ``routine use'' portion of the system be 
published for comment, CMS invites comments on all portions of this 
notice. See EFFECTIVE DATES section for comment period.

EFFECTIVE DATES: CMS filed a new system report with the Chair of the 
House Committee on Government Reform and Oversight, the Chair of the 
Senate Committee on Governmental Affairs, and the Administrator, Office 
of Information and Regulatory Affairs, Office of Management and Budget 
(OMB) on February 12, 2002. In any event, we will not disclose any 
information under a routine use until 40 days after publication. We may 
defer implementation of this system of records or one or more of the 
routine use statements listed below if we receive comments that 
persuade us to defer implementation.

ADDRESSES: The public should address comments to: Director, Division of 
Data Liaison and Distribution (DDLD), 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: Angela Brice-Smith (410) 786-4340, 
Office of Financial Management, CMS, and 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

SUPPLEMENTARY INFORMATION:

I. Description of the New System of Records

Statutory and Regulatory Basis for System of Records

    Under sections 1128 A and B and 1156 of the Social Security Act the 
Department of Health and Human Services through the Office of the 
Inspector General (OIG) was given the authority to Exclude certain 
individuals and entities from participation in the Medicare and other 
Federal and State health care programs. The Medicare contractors are 
responsible for ensuring that no payment is made with respect to any 
item or service (other than an emergency item or service) furnished by 
an individual or entity during the period when such individual or 
entity is excluded from participation in Medicare. The exclusion also 
covers orders and referrals for items or services, as well as ownership 
or management of entities that provide items or services to Medicare 
beneficiaries.
    CMS has recently surveyed the Medicare contractors regarding their 
ability to successfully enforce OIG exclusions. A number of problems 
with the current operational process have been identified, some of 
which directly relate to the data that CMS receives from the OIG and 
provides to the contractors. The data problems include a lack of 
standardized format for the cumulative exclusion database, incomplete 
data, and lack of a process to update exclusion data. Additionally, CMS 
currently does not have an efficient mechanism to determine which 
organizations employ excluded individuals.
    In order to assist our contractors in determining that no excluded 
individual or entity receives Medicare payment, CMS will create and 
maintain a cumulative exclusion database. CMS will be able to match 
this database against files of providers billing Medicare to ensure 
that excluded individuals and entities do not violate the terms of 
their exclusion. In the long term, the MED will be available to a 
number of users, including all Medicare contractors, the Provider 
Enrollment Chain and Ownership System (PECOS) and, potentially, 
Medicaid State Agencies.
    The MED project is divided into three phases. Phase I requires that 
a database be developed, populated and maintained in a standard format 
which contains the cumulative exclusion database containing all 
individuals and entities excluded from the Medicare program. The goals 
of Phase I are to analyze the OIG Exclusion file, clean up

[[Page 8811]]

and standardize the data, load a Medicare Exclusion Database (MED) and 
produce an extract file from the cleaned and standardized data.
    Phase II requires that the data from the (MED) database is matched 
against data from CMS's Online Survey Certification and Reporting 
System (OSCAR) file, National Supplier Clearinghouse (NSC) file, Unique 
Physician Identification Number (UPIN) Registry, and Medicare 
contractor (fiscal intermediaries and carriers) provider files to 
determine that no excluded individual or entity is doing business with 
Medicare or Medicare providers and suppliers. Phase II will produce 
some basic Medicare Exclusion Database reporting for CMS's internal 
use.
    Phase III will involve an open-ended analysis to identify 
additional tools CMS might use to determine who employs excluded 
individuals to ensure that employers of excluded individuals are not 
receiving payments from the Medicare program.

II. Collection and Maintenance of Data in the System

A. Scope of the Data Collected

    The system of records will contain data elements that identify 
individuals and entities excluded from participation in the Medicare 
program:

Individual/Entity Name
Unique Physician Identification Number (UPIN)
Date of Birth
SSN
Address
Sanction Type
Sanction Date
Reinstatement Date
Date of Death
Name History
Date of Birth History
Address History
SSN History
UPIN History
EIN History
UPIN Match
OSCAR Match
NSC Match

B. Agency Policies, Procedures, and Restrictions on the Routine Use

    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 MED information that can be associated 
with an individual patient as provided for under ``Section III. 
Entities Who May Receive Disclosures Under Routine Use.'' Both 
identifiable and non-identifiable data may be disclosed under a routine 
use. Identifiable data includes individual records with MED information 
and identifiers. Non-identifiable data includes individual records with 
MED information and masked identifiers or MED information with 
identifiers stripped out of the file.
    We will only disclose the minimum personal data necessary to 
achieve the purpose of the MED. CMS has the following policies and 
procedures concerning disclosures of information that will be 
maintained in the system. In general, disclosure of information from 
the SOR will be approved only for the minimum information necessary to 
accomplish the purpose of the disclosure after CMS:
    1. Determines that the use or disclosure is consistent with the 
reason that the data is being collected; e.g., developing and refining 
payment systems and monitoring the quality of care provided to 
patients.
    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
    b. Unauthorized use of disclosure of the record;
    c. Remove or destroy at the earliest time all patient-identifiable 
information; and
    d. 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. Proposed Routine Use Disclosures of Data in the System

A. Entities Who May Receive Disclosures Under Routine Use

    These routine uses specify circumstances, in addition to those 
provided by statute in the Privacy Act of 1974, under which CMS may 
release information from the MED without the consent of the individual 
to whom such information pertains. Each proposed disclosure of 
information under these routine uses will be evaluated to ensure that 
the disclosure is legally permissible, including but not limited to 
ensuring that the purpose of the disclosure is compatible with the 
purpose for which the information was collected. We are proposing to 
establish the following routine use disclosures of information 
maintained in the system:
    1. To agency contractors, or consultants who have been contracted 
by the agency to assist in the performance of a service related to this 
system of records 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 agency business 
functions relating to purposes for this system of records.
    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 whatever information is necessary for the 
contractor to fulfill its duties. In these situations, safeguards are 
provided in the contract prohibiting the contractor from using or 
disclosing the information for any purpose other than that described in 
the contract and requires the contractor to return or destroy all 
information at the completion of the contract.
    2. To the agency of a State Government, or established by State 
law, for purposes of ensuring that no payments are made with respect to 
any item or service furnished by an individual or entity during the 
period when such individual or entity is excluded from participation in 
Medicare and other Federal and State health care programs.
    MED data may potentially be released to the State only on those 
individuals who are either individuals or entities excluded from 
participation in the Medicare and other Federal and State health care 
programs, or employers of excluded individuals or entities, or are 
legal residents of the State, irrespective of the location of provider 
or supplier furnishing items or services.
    3. To another Federal or State Agency:
    a. To contribute to the accuracy of CMS's proper payment of 
Medicare benefits,
    b. To 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

[[Page 8812]]

implements a health benefits program funded in whole or in part with 
Federal funds.
    Other Federal or State agencies in their administration of a 
Federal health program may require MED information in order to support 
evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper payment for services provided. Releases 
of information would be allowed if the proposed use(s) for the 
information proved compatible with the purpose for which CMS collects 
the information.
    4. To an individual or organization for research, evaluation or 
epidemiological projects related to the prevention of disease or 
disability, the restoration or maintenance of health, or for 
understanding and improving payment projects.
    The MED data will provide the research and evaluations a broader, 
longitudinal, national perspective of the status of individuals that 
are excluded from participation in Medicare. CMS anticipates that many 
researchers will have legitimate requests to use these data in projects 
that could ultimately improve the care provided to Medicare patients 
and the policy that governs the care. CMS understands the concerns 
about the privacy and confidentiality of the release of data for a 
research use.
    5. To a Member of Congress or to a congressional staff member in 
response to an inquiry of the Congressional Office made at the written 
request of the constituent about whom the record is maintained.
    Beneficiaries sometimes request the help of a Member of Congress in 
resolving some issue relating to a matter before CMS. The Member of 
Congress then writes CMS, and CMS must be able to give sufficient 
information to be responsive to the inquiry.
    6. 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.
    Whenever CMS is involved in litigation, or occasionally when 
another party is involved in litigation and CMS's 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. A determination would be made in each instance that, 
under the circumstances involved, the purposes served by the use of the 
information in the particular litigation is compatible with a purpose 
for which CMS collects the information.
    7. To a CMS contractor (including, but not necessarily limited to 
fiscal intermediaries and carriers) 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.
    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 functions 
relating to the purpose of combating fraud and abuse.
    CMS occasionally contracts out certain of its functions when this 
would contribute to effective and efficient operations. CMS must be 
able to give a contractor whatever information is necessary for the 
contractor to fulfill its duties. In these situations, safeguards (like 
ensuring that 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 those stated in II.B above), are provided in the contract 
prohibiting the contractor from using or disclosing the information for 
any purpose other than that described in the contract and to return or 
destroy all information.
    8. 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.
    Other State agencies in their administration of a Federal health 
program may require MED information for the purpose of preventing, 
deterring, discovering, detecting, investigating, examining, 
prosecuting, suing with respect to, defending against, correcting, 
remedying, or otherwise combating such fraud and abuse in such 
programs. Releases of information would be allowed if the proposed 
use(s) for the information proved compatible with the purpose for which 
CMS collects the information.

B. Additional Provisions Affecting Routine Use Disclosures

    In addition, our policy will be to prohibit release even of non-
identifiable data, except pursuant to one of the routine uses, if there 
is a possibility that an individual can be identified through implicit 
deduction based on small cell sizes (instances where the patient 
population is so small that individuals who are familiar with the 
enrollees could, because of the small size, use this information to 
deduce the identity of the beneficiary).
    This System of Records contains Protected Health Information as 
defined by the Department of Health and Human Services' regulation 
``Standards for Privacy of Individually Identifiable Health 
Information'' (45 CFR parts 160 and 164, 65 FR 82462 as amended by 66 
FR 12434). Disclosures of Protected Health Information authorized by 
these routine uses may only be made if, and as, permitted or required 
by the ``Standards for Privacy of Individually Identifiable Health 
Information.''

IV. Safeguards

    The MED system will conform to applicable law and policy governing 
the privacy and security of Federal automated information systems. 
These include but are not limited to: the Privacy Act of 1984, Computer 
Security Act of 1987, the Paperwork Reduction Act of 1995, the Clinger-
Cohen Act of 1996, and OMB Circular A-130, Appendix III, ``Security of 
Federal Automated Information Resources.'' CMS has prepared a 
comprehensive system security plan as required by OMB Circular A-130, 
Appendix III. This plan conforms fully to guidance issued by the 
National Institute for Standards and Technology (NIST) in NIST Special 
Publication 800-18, ``Guide for Developing Security Plans for 
Information Technology Systems.'' Paragraphs A-C of this section 
highlight some of the specific methods that CMS is using to ensure the 
security of this system and the information within it.

A. Authorized Users

    Personnel having access to the system have been trained in Privacy 
Act requirements. Employees who maintain records in the system are 
instructed not

[[Page 8813]]

to release any data until the intended recipient agrees to implement 
appropriate administrative, technical, procedural, and physical 
safeguards sufficient to protect the confidentiality of the data and to 
prevent unauthorized access to the data. Records are used in a 
designated work area and system location is attended at all times 
during working hours.
    To ensure security of the data, the proper level of class user is 
assigned for each individual user level. This prevents unauthorized 
users from accessing and modifying critical data. The system database 
configuration includes five classes of database users:
     Database Administrator class owns the database objects 
(e.g., tables, triggers, indexes, stored procedures, packages) and has 
database administration privileges to these objects.
     Quality Control Administrator class has read and write 
access to key fields in the database;
     Quality Index Report Generator class has read-only access 
to all fields and tables;
     Policy Research class has query access to tables, but are 
not allowed to access confidential patient identification information; 
and
     Submitter class has read and write access to database 
objects, but no database administration privileges.

B. Physical Safeguards

    All server sites will implement the following minimum requirements 
to assist in reducing the exposure of computer equipment and thus 
achieve an optimum level of protection and security for the CMS system:
    Access to all servers is to be controlled, with access limited to 
only those support personnel with a demonstrated need for access. 
Servers are to be kept in a locked room accessible only by specified 
management and system support personnel. Each server is to require a 
specific log-on process. All entrance doors are identified and marked. 
A log is kept of all personnel who were issued a security card, key 
and/or combination, which grants access to the room housing the server, 
and all visitors are escorted while in this room. All servers are 
housed in an area where appropriate environmental security controls are 
implemented, which include measures implemented to mitigate damage to 
Automated Information Systems (AIS) resources caused by fire, 
electricity, water and inadequate climate controls.
    Protection applied to the workstations, servers and databases 
include:
     User Log-on--Authentication is to be performed by the 
Primary Domain Controller/Backup Domain Controller of the log-on 
domain.
     Workstation Names--Workstation naming conventions may be 
defined and implemented at the agency level.
     Hours of Operation--May be restricted by Windows NT. When 
activated all applicable processes will automatically shut down at a 
specific time and not be permitted to resume until the predetermined 
time. The appropriate hours of operation are to be determined and 
implemented at the agency level.
     Inactivity Lockout--Access to the NT workstation is to be 
automatically locked after a specified period of inactivity.
     Warnings--Legal notices and security warnings are to be 
displayed on all servers and workstations.
     Remote Access Security--Windows NT Remote Access Service 
(RAS) security handles resource access control. Access to NT resources 
is to be controlled for remote users in the same manner as local users, 
by utilizing Windows NT file and sharing permissions. Dial-in access 
can be granted or restricted on a user-by-user basis through the 
Windows NT RAS administration tool.

C. Procedural Safeguards

    All automated systems must comply with Federal laws, guidance, and 
policies for information systems security. These include, but are not 
limited to: the Privacy Act of 1974; the Computer Security Act of 1987; 
OMB Circular A-130, revised; Information Resource Management (IRM) 
Circular #10; HHS Automated Information Systems Security Program; the 
CMS Information Systems Security Policy, Standards, and Guidelines 
Handbook; and other CMS systems security policies. Each automated 
information system should ensure a level of security commensurate with 
the level of sensitivity of the data, risk, and magnitude of the harm 
that may result from the loss, misuse, disclosure, or modification of 
the information contained in the system.

V. Effects of the New System 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 monitor the collection and reporting of MED data. MED 
information is submitted to CMS through standard systems. CMS will 
utilize a variety of onsite and offsite edits and audits to increase 
the accuracy of MED data.
    CMS will take precautionary measures (see item IV. above) 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 is maintained in the 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 maintaining this system of records.

    Dated: February 12, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
09-70-0534

System Name:
    Medicare Exclusion Database (MED).

Security Classification:
    Level 3, Privacy Act Sensitive.

System Location:
    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850 and CMS contractors and agents at 
various locations.

Categories of Individuals Covered by the System:
    The system of records will contain data elements that identify 
individuals and entities excluded from participation in the Medicare 
program.

Categories of Records in the System:
    This system of records will contain the individual-level 
identifying data such as name, addresses, dates of birth and death, 
Medicare provider identification number, SSN, sanction and 
reinstatement information, and identifying historical data including 
name, address, dates of birth, SSN and provider numbers.

Authority for Maintenance of the System:
    Sec. 1128 A and B and 1156 of the Social Security Act.

[[Page 8814]]

Purpose(s):
    The primary purpose of this system of records is to retrieve 
information that will be used to aid in the ability of CMS and its 
contractors (private insurance companies contracted to receive, check 
and pay bills submitted by providers of services) to ensure that no 
Medicare payments are made with respect to any item or service (other 
than an emergency item or service) furnished by an individual or entity 
during the period when such individual or entity is excluded from 
participation in Medicare. The information retrieved from this system 
of records will be used to support regulatory, reimbursement, and 
policy functions performed within the agency or by a contractor or 
consultant; to another Federal or State agency to contribute to the 
accuracy of CMS's proper payment of Medicare benefits, to enable such 
agency to administer a Federal health benefits program, or 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; support constituent requests made to a 
Congressional representative; support litigation involving the agency; 
and support research, evaluation, and for payment related projects; and 
to disclose individual-specific information for the purpose of 
combating fraud and abuse in health benefits programs administered by 
CMS.

Routine Uses of Records Maintained in the System, Including Categories 
or Users and the Purposes of Such Uses:
    These routine uses specify circumstances, in addition to those 
provided by statute in the Privacy Act of 1974, under which CMS may 
release information from the MED without the consent of the individual 
to whom such information pertains. Each proposed disclosure of 
information under these routine uses will be evaluated to ensure that 
the disclosure is legally permissible, including but not limited to 
ensuring that the purpose of the disclosure is compatible with the 
purpose for which the information was collected. In addition, our 
policy will be to prohibit release even of non-identifiable data, 
except pursuant to one of the routine uses, if there is a possibility 
that an individual can be identified through implicit deduction based 
on small cell sizes (instances where the patient population is so small 
that individuals who are familiar with the enrollees could, because of 
the small size, use this information to deduce the identity of the 
beneficiary). Be advised, this System of Records contains Protected 
Health Information as defined by the Department of Health and Human 
Services' regulation ``Standards for Privacy of Individually 
Identifiable Health Information'' (45 CFR parts 160 and 164, 65 FR 8462 
as amended by 66 FR 12434). Disclosures of Protected Health Information 
authorized by these routine uses may only be made if, and as, permitted 
or required by the ``Standards for Privacy of Individually Identifiable 
Health Information.''
    1. To agency contractors or consultants who have been contracted by 
the agency to assist in the performance of a service related to this 
system of records and who need to have access to the records in order 
to perform the activity.
    2. To the agency of a State Government, or established by State 
law, for purposes of ensuring that no payments are made with respect to 
any item or service furnished by an individual or entity during the 
period when such individual or entity is excluded from participation in 
Medicare and other Federal and State health care programs.
    3. To another Federal or State agency:
    a. To contribute to the accuracy of CMS's proper payment of 
Medicare benefits,
    b. To 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.
    4. To an individual or organization for research, evaluation or 
epidemiological projects related to the prevention of disease or 
disability, or the restoration or maintenance of health, or for 
understanding and improving payment projects.
    5. To a member of Congress or to a congressional staff member in 
response to an inquiry of the Congressional Office made at the written 
request of the constituent about whom the record is maintained.
    6. 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 the 
use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    7. To a CMS contractor (including, but not necessarily limited to 
fiscal intermediaries and carriers) 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.
    8. 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 magnetic, optical and other electronic 
media

Retrievability:
    The records are retrieved by the Medicare provider number or the 
National Provider Identifier (NPI).

Safeguards:
    CMS has safeguards for authorized users and monitors such users to 
ensure against excessive or unauthorized use. Personnel having access 
to the system have been trained in the Privacy Act and systems security 
requirements. Employees who maintain records in the system are 
instructed not to release any data until the intended recipient agrees 
to implement appropriate administrative, technical, procedural, and 
physical safeguards sufficient to protect the confidentiality of the 
data and to prevent unauthorized access to the data.
    In addition, CMS has physical safeguards in place to reduce the 
exposure of computer equipment and thus achieve an optimum level of 
protection and security for the CMS system. For computerized records, 
safeguards have been established in accordance with HHS standards and

[[Page 8815]]

National Institute of Standards and Technology guidelines; e.g., 
security codes will be used, limiting access to authorized personnel. 
System securities are established in accordance with HHS, Information 
Resource Management (IRM) Circular #10, Automated Information Systems 
Security Program; CMS Information Systems Security, Standards 
Guidelines Handbook and OMB Circular No. A-130 (revised) Appendix III.

Retention and Disposal:
    CMS will retain identifiable MED data for a total period of 15 
years.

System Manager(s) and Address:
    CMS, Director, Office of Financial Management/Program Integrity 
Group, Division of Program Integrity Operations, Health Care Financing 
Administration, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850.

Notification Procedure:
    For purpose of access, the subject individual should write to the 
system manager who will require the system name, health insurance claim 
number, and for verification purposes, the subject individual's name 
(woman's maiden name, if applicable), address, age, and sex, and social 
security number (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.)

Record Source Categories:
    The OIG Exclusion file, Online Survey Certification and Reporting 
System (OSCAR) file, National Supplier Clearing House (NSC) file, 
Unique Physician Identification Number (UPIN) Registry, Medicare 
contractor provider files and Social Security Administration (SSA) 
withholding records or other information services to determine who 
employs excluded individuals.

Systems Exempted from Certain Provisions of the Act:
    None.
[FR Doc. 02-4469 Filed 2-25-02; 8:45 am]
BILLING CODE 4120-03-P