[Federal Register Volume 67, Number 208 (Monday, October 28, 2002)]
[Notices]
[Pages 65795-65801]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-27337]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of Modified or Altered System

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

ACTION: Notice of modified or altered system of records (SOR).

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to modify or alter a SOR, ``CMS Utilization 
Review Investigatory Files, System No. 09-70-0527.'' We propose to 
change the name of this system to ``CMS Fraud Investigation Database 
(FID),'' to more accurately reflect the increase in scope proposed by 
this modification. We propose to broaden the scope of responsibility 
and activities covered by this system to include activities related to 
fraud and abuse in all health care programs administered by CMS. We are 
deleting routine uses number 1 pertaining to Department of Justice 
(DOJ) for consideration of criminal prosecution or civil action, number 
2 pertaining to state or local licensing authorities (including state 
medical review boards), professional review organizations, peer review 
groups, medical consultants, or other professional associations for 
possible administrative action, number 3 pertaining to * * * officers 
and employees of state governments * * * Civilian Health and Medical 
Program of the Uniformed Services (CHAMPUS) * * * as well as states 
attorneys * * *, number 4 pertaining to * * * third parties for the 
purpose of establishing or negating a violation, number 5 pertaining to 
* * * cases involving fraudulent tax returns or forger of Medicare 
checks to the Treasury Department, postal authorities, or to 
appropriate law enforcement authorities, and an unnumbered routine use 
authorizing disclosure to the Social Security Administration (SSA).
    Disclosures of the data allowed in routine uses number 1, 2, 3, 4, 
5, and to the SSA will be accomplished by a new routine use ``to combat 
fraud and abuse in certain health benefits programs'' and will be 
numbered as routine use number 5. We propose a new routine use number 1 
specifically for the release of information in the system to a 
contractor or consultant who need to have access to the records in 
order to assist CMS. We propose a new routine use number 4 specifically 
for the release of information in the system to a contractor that 
assists in the administration of a CMS-administered health benefits 
program, or to a grantee of a CMS-administered grant program to combat 
fraud and abuse. We propose to modify the language of routine uses 
number 6 and number 7 to clarify the circumstances for disclosure under 
these routine uses and change the numbers of these routine uses to 
number 2 and number 3.
    The security classification previously reported as ``None'' will be 
modified to reflect that the data in this system is considered to be 
``Level Three Privacy Act Sensitive.'' The routine uses will then be 
prioritized and reordered according to their proposed usage. We will 
also take the opportunity to update any sections of the system that 
were affected by the recent reorganization and to update language in 
the administrative sections to correspond with language used in other 
CMS SOR.
    The primary purpose of this SOR is to identify if a violation(s) of 
a provision of the Social Security Act (the Act) or a related penal or 
civil provision of the United States Code (U.S.C.) related to Medicare 
(Title XVIII), Medicaid (Title XIX), HMO/Managed Care (Title XX), and 
Children's Health Insurance Program (Title XXI) have been committed, 
determine if HHS has made a proper payment as prescribed under 
applicable sections of the Act and whether these programs have been 
abused, coordinate investigations related to Medicare, Medicaid, HMO/
Managed Care, and Children's Health Insurance Program, and prevent 
duplications, and provide case file material to the HHS Office of 
Inspector General when a case is referred for fraud investigation. 
Information retrieved from this SOR will also be disclosed to: (1) 
Support regulatory and policy functions performed within the Agency or 
by a contractor or consultant; (2) support constituent requests made to 
congressional representatives; (3) support litigation involving the 
Agency related to this system; and (4) combat fraud and abuse in 
certain health care programs. We have provided background information 
about the modified system in the ``Supplementary Information'' section 
below. 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. See 
``Effective Dates'' section for comment period.

EFFECTIVE DATES: CMS filed a modified or altered 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 September 9, 2002. To ensure that all 
parties have adequate time in which to comment, the modified or altered 
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.

ADDRESSES: The public should address comments to: Director, Division of 
Data Liaison and Distribution, 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 daylight time.

FOR FURTHER INFORMATION CONTACT: Mark Koepke, Division of Program 
Integrity Operations, Program Integrity Group, Office of Financial 
Management, CMS, Mail-stop C3-02-16, 7500 Security Boulevard, 
Baltimore,

[[Page 65796]]

Maryland 21244-1850. The telephone number is 410-786-0524.

SUPPLEMENTARY INFORMATION:

I. Description of the Modified System

A. Statutory and Regulatory Basis for SOR

    In 1988, CMS established a SOR the authority of sections 205, 1106, 
1107, 1815, 1816, 1833, 1842, 1872, 1874, 1876, 1877, and 1902 of the 
Act, United States Code (U.S.C.) sections 405, 1306, 1307, 1395g, 
1395h, 1395l, 1395u, 1395ii, 1395kk, 1395mm, 1395nn, and 1396a). Notice 
of this system, ``CMS Utilization Review Investigatory Files, System 
No. 09-70-0527,'' was published in the Federal Register at 53 FR 52792, 
(Dec. 29, 1988), an unnumbered routine use was added for SSA at 61 FR 
6645 (Feb. 21, 1996), three new fraud and abuse routine uses were added 
at 63 FR 38414 (July 16, 1998), and then at 65 FR 50552 (Aug. 18, 
2000), two of the fraud and abuse routine uses were revised and a third 
deleted.

II. Collection and Maintenance of Data in the System

A. Scope of the Data Collected

    The system contains the name, work address, work phone number, 
social security number, Unique Provider Identification Number (UPIN), 
and other identifying demographics of individuals alleged to have 
violated provision of the Act related to Medicare, Medicaid, HMO/
Managed Care, and Children's Health Insurance Program or other 
criminal/civil statutes as they pertain to The Act programs where 
substantial basis for criminal/civil prosecution exist, defendants in 
criminal prosecution cases, or persons alleged to have abused the 
programs. The last category of individuals would, for example, include 
persons alleged to have rendered unnecessary services to Medicare 
beneficiaries or Medicaid recipients, over utilized services, or 
engaged in improper billing.

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, 
which 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 FID information that can be associated 
with an individual 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 FID information and identifiers. 
Non-identifiable data includes individual records with FID information 
and masked identifiers or FID information with identifiers stripped out 
of the file.
    We will only collect the minimum personal data necessary to achieve 
the purpose of FID. 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 system of 
records will be approved only for the minimum information necessary to 
accomplish the purpose of the disclosure only after CMS:
    1. Determines that the use or disclosure is consistent with the 
reason that the data is being collected, e.g., disclosure of 
individual-specific information for the purposes of combating fraud and 
abuse in a health benefits program funded in whole or in part by 
Federal funds.
    2. Determines:
    a. That the purpose for which the disclosure is to be made can only 
be accomplished if the record is provided in individually identifiable 
form;
    b. 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
    c. That 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 individually 
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. 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 FID 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 or modify the following routine use disclosures of 
information maintained in the system:
    1. To Agency contractors, or consultants who have been engaged by 
the Agency to assist in accomplishment of a CMS function relating to 
the purposes for this system of records and who need to have access to 
the records in order to assist CMS.
    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 a CMS function 
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 or consultant 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 or consultant from using or disclosing the information 
for any purpose other than that described in the contract and requires 
the contractor or consultant to return or destroy all information at 
the completion of the contract.
    2. 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 and other individuals often request the help of a 
Member of Congress in resolving an 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.
    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,

[[Page 65797]]

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.
    4. To a CMS contractor (including, but not 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 contract or grant 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 doing 
so would contribute to effective and efficient operations. CMS must be 
able to give a contractor or grantee whatever information is necessary 
for the contractor or grantee to fulfill its duties. In these 
situations, safeguards are provided in the contract prohibiting the 
contractor or grantee from using or disclosing the information for any 
purpose other than that described in the contract and requiring the 
contractor or grantee 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 
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 agencies may require FID information for the purpose of 
combating fraud and abuse in such Federally funded programs.

A. Additional Circumstances Affecting Routine Use Disclosures

    This SOR contains Protected Health Information as defined by HHS 
regulation ``Standards for Privacy of Individually Identifiable Health 
Information'' (45 CFR parts 160 and 164, 65 FR 82462 (12-28-00), as 
amended by 66 FR 12434 (2-26-01)). 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.''
    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).

IV. Safeguards

A. Administrative Safeguards

    The FID 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 1974, Computer 
Security Act of 1987, the Paperwork Reduction Act (PRA) 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 the Office 
and Management and Budget (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.
    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 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 or workstation and the 
system location is attended at all times during working hours.
    To assure security of the data, the proper level of class user is 
assigned for each individual user as determined at the Agency level. 
This prevents unauthorized users from accessing and modifying critical 
data. The system database configuration includes five classes of 
database users:
    [sbull] Database Administrator class owns the database objects, 
e.g., tables, triggers, indexes, stored procedures, packages, and has 
database administration privileges to these objects;
    [sbull] Quality Control Administrator class has read and write 
access to key fields in the database;
    [sbull] Quality Indicator Report Generator class has read-only 
access to all fields and tables;
    [sbull] Policy Research class has query access to tables, but are 
not allowed to access confidential personal identification information; 
and
    [sbull] Submitter class has read and write access to database 
objects, but no database administration privileges.

B. Physical Safeguards

    All server sites have implemented 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 
FID system: Access to all servers is 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 requires 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 that 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 System resources caused by fire, electricity, 
water, and inadequate climate controls.
    Protection applied to the workstations, servers and databases 
include:
    [sbull] User Log-ons--Authentication is performed by the Primary 
Domain Controller/Backup Domain Controller of the log-on domain.
    [sbull] Workstation Names--Workstation naming conventions may be 
defined and implemented at the Agency level.
    [sbull] 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

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determined and implemented at the Agency level.
    [sbull] Inactivity Log-out--Access to the NT workstation is 
automatically logged-out after a specified period of inactivity.
    [sbull] Warnings--Legal notices and security warnings display on 
all servers and workstations.
    [sbull] Remote Access Security (RAS)--Windows NT RAS security 
handles resource access control. Access to NT resources is 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 Circular 
10, HHS Automated Information Systems Security Program, the 
CMS Information Systems Security Policy and Program 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. Effect of the Modified 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 FID data. FID 
information on individuals is completed by contractor personnel and 
submitted to CMS through standard systems located at different 
locations. CMS will utilize a variety of onsite and offsite edits and 
audits to increase the accuracy of FID 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. CMS will collect only that information necessary to perform the 
system's functions. In addition, CMS will make disclosure of 
identifiable data from the modified 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 the disclosure of information 
relating to individuals.

    Dated: September 9, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
System No. 09-70-0527

System Name:
    Centers for Medicare & Medicaid Services (CMS) Fraud Investigation 
Database (FID), HHS/CMS/OFM.

Security Classification:
    Level Three Privacy Act Sensitivity.

System Location:
    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850. Information in this system is 
also maintained at various remote locations listed in appendix ``A.''

Categories of Individuals Covered by the System:
    Individuals alleged to have violated provision of the Act related 
to Medicare (Title XVIII), Medicaid (Title XIV), HMO/Managed Care 
(Title XX), and Children's Health Insurance Program (Title XXI) or 
other criminal/civil statutes as they pertain to the Act programs where 
substantial basis for criminal/civil prosecution exist, defendants in 
criminal prosecution cases, or persons alleged to have abused the 
programs.

Categories of Records in the System:
    The system contains the name, work address, work phone number, 
social security number, Unique Provider Identification Number (UPIN), 
and other identifying demographics of individuals alleged to have 
violated provision of the Act or persons alleged to have abused 
Medicare and/or Medicaid programs.

Authority for Maintenance of the System:
    This system was established under the authority of sections 205, 
1106, 1107, 1815, 1816, 1833, 1842, 1872, 1874, 1876, 1877, and 1902 of 
the Act (Title 42 United States Code (U.S.C.) sections 405, 1306, 1307, 
1395g, 1395h, 1395l, 1395u, 1395ii, 1395kk, 1395mm, 1395nn, and 1396a).

Purpose(s):
    The primary purpose of the system of records is to identify if a 
violation(s) of a provision of the Act or a related penal or civil 
provision of the United States Code (U.S.C.) related to Medicare (Title 
XVIII), Medicaid (Title XIV), HMO/Managed Care (Title XX), and 
Children's Health Insurance Program (Title XXI) have been committed, 
determine if HHS has made a proper payment as prescribed under 
applicable sections of the Act and whether these programs have been 
abused, coordinate investigations related to Medicare, Medicaid, HMO/
Managed Care, and Children's Health Insurance Program, and prevent 
duplications, and provide case file material to the HHS Office of the 
Inspector General when a case is referred for fraud investigation. 
Information retrieved from this system of records will also be 
disclosed to: support regulatory and policy functions performed within 
the Agency or by a contractor or consultant, support constituent 
requests made to a congressional representative, support litigation 
involving the Agency related to this system of records, and to combat 
fraud and abuse in certain health care programs.

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 FID 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).
    This SOR contains Protected Health Information as defined by HHS 
regulation ``Standards for Privacy of Individually Identifiable Health 
Information'' (45 CFR parts 160 and 164, 65 FR 82462, December 28, 
2000, as amended by 66 FR 12434, February 26,

[[Page 65799]]

2001). 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.'' We are proposing to establish or modify the following 
routine use disclosures of information maintained in the system:
    1. To Agency contractors, or consultants who have been engaged by 
the Agency to assist in accomplishment of a CMS function relating to 
the purposes for this system of records and who need to have access to 
the records in order to assist CMS.
    2. 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.
    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.
    4. To a CMS contractor (including, but not 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.
    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:
    Computer diskette and on magnetic storage media.

RETRIEVABILITY:
    Information can be retrieved by the name of the subject of the 
investigation and assigned UPIN number.

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 FID system. For computerized records, 
safeguards have been established in accordance with the Department of 
Health and Human Services (HHS) standards and 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 
Circular 10, Automated Information Systems Security Program; 
CMS Automated Information Systems Guide, Systems Securities Policies, 
and OMB Circular No. A-130 (revised) appendix III.

RETENTION AND DISPOSAL:
    Records are maintained 15 years in a secure storage area with 
identifiers.

SYSTEM MANAGER(S) AND ADDRESSES:
    Director, Program Integrity Group, Office of Financial Management, 
CMS, 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, social security number 
(SSN) or UPIN, address, date of birth, and sex, and for verification 
purposes, the subject individual's name (woman's maiden name, if 
applicable). 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:
    Sources of information contained in this records system include 
data collected from FID computer files as transmitted by the contractor 
sites.

SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
    HHS claims exemption of certain records (case files on active fraud 
investigations) in the system from notification and access procedures 
under 5 U.S.C. 522a (k)(2) inasmuch as these records are investigatory 
materials compiled for program (law) enforcement in anticipation of a 
criminal or administrative proceedings. (See Department Regulation (45 
CFR 5b.11))

Appendix A. Health Insurance Claims

    Medicare records are maintained at the CMS Central Office (see 
section 1 below for the address). Health Insurance Records of the 
Medicare program can also be accessed through a representative of 
the CMS Regional Office (see section 2 below for addresses). 
Medicare claims records are also maintained by private insurance 
organizations that share in administering provisions of the health 
insurance programs. These private insurance organizations, referred 
to as carriers and intermediaries, are under contract to the Health 
Care Financing Administration and the Social Security Administration 
to perform specific task in the Medicare program (see section three 
below for addresses for intermediaries, section four addresses the 
carriers, and section five addresses the Payment Safeguard 
Contractors.

I. Central Office Address

    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850.

[[Page 65800]]

II. CMS Regional Offices

    Boston Region--Connecticut, Maine, Massachusetts, New Hampshire, 
Rhode Island, Vermont. John F. Kennedy Federal Building, Room 1211, 
Boston, Massachusetts 02203. Office Hours: 8:30 a.m.-5 p.m.
    New York Region--New Jersey, New York, Puerto Rico, Virgin 
Islands. 26 Federal Plaza, Room 715, New York, New York 10007, 
Office Hours: 8:30 a.m.-5 p.m.
    Philadelphia Region--Delaware, District of Columbia, Maryland, 
Pennsylvania, Virginia, West Virginia. Post Office Box 8460, 
Philadelphia, Pennsylvania 19101. Office Hours: 8:30 a.m.-5 p.m.
    Atlanta Region--Alabama, North Carolina, South Carolina, 
Florida, Georgia, Kentucky, Mississippi, Tennessee. 101 Marietta 
Street, Suite 702, Atlanta, Georgia 30223, Office Hours: 8:30 a.m.-
4:30 p.m.
    Chicago Region--Illinois, Indiana, Michigan, Minnesota, Ohio, 
Wisconsin. Suite A--824, Chicago, Illinois 60604. Office Hours: 8 
a.m.-4:45 p.m.
    Dallas Region--Arkansas, Louisiana, New Mexico, Oklahoma, Texas, 
1200 Main Tower Building, Dallas, Texas. Office Hours: 8 a.m.-4:30 
p.m.
    Kansas City Region--Iowa, Kansas, Missouri, Nebraska. New 
Federal Office Building, 601 East 12th Street Room 436, Kansas City, 
Missouri 64106. Office Hours: 8 a.m.-4:45 p.m.
    Denver Region--Colorado, Montana, North Dakota, South Dakota, 
Utah, Wyoming. Federal Office Building, 1961 Stout St Room 1185, 
Denver, Colorado 80294. Office Hours: 8 a.m.-4:30 p.m.
    San Francisco Region--American Samoa, Arizona, California, Guam, 
Hawaii, Nevada. Federal Office Building, 10 Van Ness Avenue, 20th 
Floor, San Francisco, California 94102. Office Hours: 8 a.m.-4:30 
p.m.
    Seattle Region--Alaska, Idaho, Oregon, Washington. 1321 Second 
Avenue, Room 615, Mail Stop 211, Seattle, Washington 98101. Office 
Hours 8 a.m.-4:30 p.m.

III. Intermediary Addresses (Hospital Insurance)

    Medicare Coordinator, Assoc. Hospital Serv. Maine (ME BC), 2 
Gannett Drive South, Portland, ME 04106-6911.
    Medicare Coordinator, Anthem New Hampshire, 300 Goffs Falls 
Road, Manchester, NH 03111-0001.
    Medicare Coordinator, BC/BS Rhode Island (RI BC), 444 
Westminster Street, Providence, RI 02903-3279.
    Medicare Coordinator, Empire Medicare Services, 400 S. Salina 
Street, Syracuse, NY 13202.
    Medicare Coordinator, Cooperativa, PO Box 363428, San Juan, PR 
00936-3428.
    Medicare Coordinator, Maryland B/C, PO Box 4368, 1946 
Greenspring Ave., Timonium, MD 21093.
    Medicare Coordinator, Highmark, P5103, 120 Fifth Avenue Place, 
Pittsburgh, PA 15222-3099.
    Medicare Coordinator, United Government Services, 1515 N. 
Rivercenter Dr., Milwaukee, WI 53212.
    Medicare Coordinator, Alabama B/C, 450 Riverchase Parkway East, 
Birmingham, AL 35298.
    Medicare Coordinator, Florida B/C, 532 Riverside Ave., 
Jacksonville, FL 32202-4918.
    Medicare Coordinator, Georgia B/C, PO Box 9048, 2357 Warm 
Springs Road, Columbus, GA 31908.
    Medicare Coordinator, Mississippi B/C B MS, PO Box 23035, 3545 
Lakeland Drive, Jackson, MI 39225-3035.
    Medicare Coordinator, North Carolina B/C, PO Box 2291, Durham, 
NC 27702-2291.
    Medicare Coordinator, Palmetto GBA A/RHHI, 17 Technology Circle, 
Columbia, SC 29203-0001.
    Medicare Coordinator, Tennessee B/C, 801 Pine Street, 
Chattanooga, TN 37402-2555.
    Medicare Coordinator, Anthem Insurance Co. (Anthm IN), PO Box 
50451, 8115 Knue Road, Indianapolis, IN 46250-1936.
    Medicare Coordinator, Arkansas B/C, 601 Gaines Street, Little 
Rock, AR 72203.
    Medicare Coordinator, Group Health of Oklahoma, 1215 South 
Boulder, Tulsa, OK 74119-2827.
    Medicare Coordinator, Trailblazer, PO Box 660156, Dallas, TX 
75266-0156.
    Medicare Coordinator, Cahaba GBA, Station 7, 636 Grand Avenue, 
Des Moines, IA 50309-2551.
    Medicare Coordinator, Kansas B/C, PO Box 239, 1133 Topeka Ave., 
Topeka, KS 66629-0001.
    Medicare Coordinator, Nebraska B/C, PO Box 3248, Main PO 
Station, Omaha, NE 68180-0001.
    Medicare Coordinator, Mutual of Omaha, PO Box 1602, Omaha, NE 
68101.
    Medicare Coordinator, Montana B/C, PO Box 5017, Great Falls 
Div., Great Falls, MT 59403-5017.
    Medicare Coordinator, Noridian, 4510 13th Avenue SW., Fargo, ND 
58121-0001.
    Medicare Coordinator, Utah B/C, PO Box 30270, 2455 Parleys Way, 
Salt Lake City, UT 84130-0270.
    Medicare Coordinator, Wyoming B/C, 4000 House Avenue, Cheyenne, 
WY 82003.
    Medicare Coordinator, Arizona B/C, PO Box 37700, Phoenix, AZ 
85069.
    Medicare Coordinator, UGS, PO Box 70000, Van Nuys, CA 91470-
0000.
    Medicare Coordinator, Regents BC, PO Box 8110 M/S D-4A, 
Portland, OR 97207-8110.
    Medicare Coordinator, Premera BC, PO Box 2847, Seattle, WA 
98111-2847.

IV. Medicare Carriers

    Medicare Coordinator, NHIC, 75 Sargent William Terry Drive, 
Hingham, MA 02044.
    Medicare Coordinator, B/S Rhode Island (RI BS), 444 Westminster 
Street, Providence, RI 02903-2790.
    Medicare Coordinator, Trailblazer Health Enterprises, Meriden 
Park, 538 Preston Ave., Meriden, CT 06450.
    Medicare Coordinator, Upstate Medicare Division, 11 Lewis Road, 
Binghamton, NY 13902.
    Medicare Coordinator, Empire Medicare Services, 2651 Strang 
Blvd., Yorktown Heights, NY, 10598.
    Medicare Coordinator, Empire Medicare Services, NJ, 300 East 
Park Drive, Harrisburg, PA 17106.
    Medicare Coordinator, Triple S, 1441 F.D., Roosvelt 
Ave., Guaynabo, PR 00968.
    Medicare Coordinator, Group Health Inc., 4th Floor, 88 West End 
Avenue, New York, NY 10023.
    Medicare Coordinator, Highmark, PO Box 89065, 1800 Center 
Street, Camp Hill, PA 17089-9065.
    Medicare Coordinator, Trailblazers Part B, 11150 McCormick 
Drive, Executive Plaza 3 Suite 200, Hunt Valley, MD 21031.
    Medicare Coordinator, Trailblazer Health Enterprises, Virginia, 
PO Box 26463, Richmond, VA 23261-6463. United Medicare Coordinator, 
Tricenturion, 1 Tower Square, Hartford, CT 06183.
    Medicare Coordinator, Alabama B/S, 450 Riverchase Parkway East, 
Birmingham, AL 35298.
    Medicare Coordinator, Cahaba GBA, 12052 Middleground Road, Suite 
A, Savannah, GA 31419.
    Medicare Coordinator, Florida B/S, 532 Riverside Ave, 
Jacksonville, FL 32202-4918.
    Medicare Coordinator, Administar Federal, 9901 Linnstation Road, 
Louisville, KY 40223.
    Medicare Coordinator, Palmetto GBA, 17 Technology Circle, 
Columbia, SC 29203-0001.
    Medicare Coordinator, CIGNA, 2 Vantage Way, Nashville, TN 37228.
    Medicare Coordinator, Railroad Retirement Board, 2743 Perimeter 
Parkway, Building 250, Augusta, GA 30999.
    Medicare Coordinator, Cahaba GBA, Jackson Miss, PO Box 22545, 
Jackson, MI 39225-2545.
    Medicare Coordinator, Adminastar Federal (IN), 8115 Knue Road, 
Indianapolis, IN 46250-1936.
    Medicare Coordinator, Wisconsin Physicians Service, PO Box 8190, 
Madison, WI 53708-8190.
    Medicare Coordinator, Nationwide Mutual Insurance Co., PO Box 
16788, 1 Nationwide Plaza, Columbus, OH 43216-6788.
    Medicare Coordinator, Arkansas B/S, 601 Gaines Street, Little 
Rock, AR 72203.
    Medicare Coordinator, Arkansas-New Mexico, 601 Gaines Street, 
Little Rock, AR 72203.
    Medicare Coordinator, Palmetto GBA-DMERC, 17 Technology Circle, 
Columbia, SC 29203-0001.
    Medicare Coordinator, Trailblazer Health Enterprises, 901 South 
Central Expressway, Richardson, TX 75080.
    Medicare Coordinator, Nordian, 636 Grand Avenue, Des Moines, IA 
50309-2551.
    Medicare Coordinator, Kansas B/S, PO Box 239, 1133 Topeka Ave., 
Topeka, KS 66629-0001.
    Medicare Coordinator, Kansas B/S-NE, PO Box 239, 1133 Topeka 
Ave., Topeka, KS 66629-0239.
    Medicare Coordinator, Montana B/S, PO Box 4309, Helena, MT 
59601.
    Medicare Coordinator, Nordian, 4305 13th Avenue South, Fargo, ND 
58103-3373.
    Medicare Coordinator, Noridian BCBSND (C0), 730 N. Simms 
100, Golden, CO 80401-4730.
    Medicare Coordinator, Noridian BCBSND (WY), 4305 13th Avenue 
South, Fargo, ND 58103-3373.
    Medicare Coordinator, Utah B/S, PO Box 30270, 2455 Parleys Way, 
Salt Lake City, UT 84130-0270.

[[Page 65801]]

    Medicare Coordinator, Transamerica Occidental, PO Box 54905, Los 
Angeles, CA 90054-4905.
    Medicare Coordinator, NHIC--California, 450 W. East Avenue, 
Chico, CA 95926.
    Medicare Coordinator, Cigna, Suite 254, 3150 Lakeharbor, Boise, 
ID 83703.
    Medicare Coordinator, Cigna, Suite 506, 2 Vantage Way, 
Nashville, TN 37228.

V. Payment Safeguard Contractors

    Medicare Coordinator, Aspen Systems Corporation, 2277 Research 
Blvd., Rockville, MD 20850.
    Medicare Coordinator, DynCorp Electronic Data Systems (EDS, 
11710 Plaza America Drive 5400 Legacy Drive, Reston, VA 20190-6017.
    Medicare Coordinator, Lifecare Management Partners Mutual of 
Omaha Insurance Co. 6601 Little River Turnpike, Suite 300 Mutual of 
Omaha Plaza, Omaha, NE 68175.
    Medicare Coordinator, Reliance Safeguard Solutions, Inc., PO Box 
30207 400 South Salina Street, 2890 East Cottonwood Pkwy. Syracuse, 
NY 13202.
    Medicare Coordinator, Science Applications International, Inc., 
6565 Arlington Blvd., PO Box 100282, Falls Church, VA.
    Medicare Coordinator, California Medical Review, Inc., 
Integriguard Division Federal Sector Civil Group, One Sansome 
Street, San Francisco, CA 94104-4448.
    Medicare Coordinator, Computer Sciences Corporation, Suite 600 
3120 Timanus Lane, Baltimore, MD 21244.
    Medicare Coordinator, Electronic Data Systems (EDS), 11710 Plaza 
America Drive 5400 Legacy Drive, Plano, TX 75204.
    Medicare Coordinator, TriCenturion, L.L.C., PO Box 100282, 
Columbia, SC 29202.
[FR Doc. 02-27337 Filed 10-25-02; 8:45 am]
BILLING CODE 4120-03-P