[Federal Register Volume 71, Number 248 (Wednesday, December 27, 2006)]
[Notices]
[Pages 77759-77765]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-22139]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of a Modified or Altered System of 
Records

AGENCY: Department of Health and Human Services (HHS), Centers for 
Medicare & Medicaid Services (CMS).

ACTION: Notice of a 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 Fraud 
Investigation Database (FID), System No. 09-70-0527,'' most recently 
modified at 67 FR 65795 (October 28, 2002). We propose to modify 
existing routine use number 1 that permits disclosure to agency

[[Page 77760]]

contractors and consultants to include disclosure to CMS grantees who 
perform a task for the agency. CMS grantees, charged with completing 
projects or activities that require CMS data to carry out that 
activity, are classified separate from CMS contractors and/or 
consultants. The modified routine use will remained as routine use 
number 1. We will delete routine use number 2 authorizing disclosure to 
support constituent requests made to a congressional representative. If 
an authorization for the disclosure has been obtained from the data 
subject, then no routine use is needed. The Privacy Act allows for 
disclosures with the ``prior written consent'' of the data subject.
    We propose to broaden the scope of the disclosure provisions of 
this system by adding a routine use to permit the release of 
information to another Federal and state agencies to: (1) Contribute to 
the accuracy of CMS' proper payment of Medicare benefits; (2) enable 
such agency to administer a Federal health benefits program, and/or (3) 
assist Federal/state Medicaid programs within the state. We will 
broaden the scope of routine uses number 4 and 5 authorizing 
disclosures to combat fraud and abuse in the Medicare and Medicaid 
programs to include combating ``waste'' which refers to specific 
beneficiary/recipient practices that result in unnecessary cost to all 
Federally-funded health benefit programs.
    We are modifying the language in the remaining routine uses to 
provide a proper explanation as to the need for the routine use and to 
provide clarity to CMS's intention to disclose individual-specific 
information contained in this system. The routine uses will then be 
prioritized and reordered according to their usage. We will also take 
the opportunity to update any sections of the system that were affected 
by the recent reorganization or because of the impact of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) 
(Pub. L. 108-173) provisions and to update language in the 
administrative sections to correspond with language used in other CMS 
SORs.
    The primary purpose of the system of records is to collect and 
maintain information to: (1) 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; 
(2) determine if HHS has made a proper payment as prescribed under 
applicable sections of the Act; (3) determine whether these programs 
have been abused; and (4) coordinate investigations related to 
Medicare, Medicaid, HMO/Managed Care, and Children's Health Insurance 
Program; (5) prevent duplications investigatory efforts; and (5) 
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: (1) Support 
regulatory, reimbursement, and policy functions performed within the 
Agency or by a contractor, consultant, or a CMS grantee; (2) assist 
another Federal and/or state agency, agency of a state government, an 
agency established by state law, or its fiscal agent; (3) support 
litigation involving the Agency related to this system of records; and 
(4) combat fraud, waste, 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 Homeland Security & Governmental 
Affairs, and the Administrator, Office of Information and Regulatory 
Affairs, Office of Management and Budget (OMB) on December 20, 2006. To 
ensure that all parties have adequate time in which to comment, the 
modified system, including routine uses, will become effective 30 days 
from the publication of the notice, or 40 days from the date it was 
submitted to OMB and Congress, whichever is later, unless CMS receives 
comments that require alterations to this notice.

ADDRESSES: The public should address comments to: CMS Privacy Officer, 
Division of Privacy Compliance, Enterprise Architecture and Strategy 
Group, 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 time zone.

FOR FURTHER INFORMATION CONTACT: Tara Ross, Health Insurance 
Specialist, Program Integrity Group, Office of Financial Management, 
CMS, Mail Stop C3-02-16, 7500 Security Boulevard, Baltimore, Maryland 
21244-1850. The telephone number is (410) 786-9530 or e-mail 
[email protected].

SUPPLEMENTARY INFORMATION:

I. Description of the Modified or Altered System of Records

A. Statutory and Regulatory Basis for SOR

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

B. Collection and Maintenance of Data in the System

    Individuals alleged to have violated provision of the Act related 
to Medicare (Title XVIII), Medicaid (Title XIX), HMO/Managed Care 
(Title XX), and Children's Health Insurance Program (Title XXI) or 
other criminal/civil statutes as they pertain to the Social Security 
Act (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 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.

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

A. 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 FID information that can be associated 
with an individual as provided for under ``Section III. Proposed 
Routine Use Disclosures of Data in the System.'' Both individually 
identifiable and non-individually-identifiable data may be disclosed 
under a routine use.
    We will only disclose 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. Disclosure of

[[Page 77761]]

information from the system will be approved only to the extent 
necessary to accomplish the purpose of the disclosure and only after 
CMS:
    1. Determines that the use or disclosure is consistent with the 
reason the data are being collected; e.g., is to identify if a 
violation(s) of a provision of the Social Security Act or a related 
penal or civil provision of the United States Code.
    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 unauthorized use or 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. The Privacy Act allows 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 compatible use of data is known as a ``routine 
use.'' The proposed routine uses in this system meet the compatibility 
requirement of the Privacy Act. We are proposing to establish the 
following routine use disclosures of information maintained in the 
system:
    1. To support Agency contractors, consultants, or grantees that 
have been contracted by the Agency to assist in accomplishment of a CMS 
function relating to the purposes for this system and who need 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.
    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, consultant, or grantee whatever information 
is necessary for the contractor, consultant, or grantee to fulfill its 
duties. In these situations, safeguards are provided in the contract 
prohibiting the contractor, consultant, or grantee 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 assist another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to:
    a. contribute to the accuracy of CMS's proper payment of Medicare 
benefits,
    b. 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, and/or
    c. assist Federal/state Medicaid programs within the state.
    Other Federal or State agencies in their administration of a 
Federal health program may require FID information in order to support 
evaluations and monitoring of Medicare claims information of 
beneficiaries, including proper payment for services provided.
    FID data may be disclosed to a state agency, agency of a state 
government, an agency established by state law, or its fiscal agent for 
purposes of ensuring that no payments are made with respect to any item 
or service furnished by an individual during the period when excluded 
from participation in Medicare and other Federal and state health care 
programs.
    FID data may potentially be released to the state only on those 
individuals who are either individuals excluded from participation in 
the Medicare and other Federal and state health care programs, or 
employers of excluded individuals, or are legal residents of the State, 
irrespective of the location of provider or supplier furnishing items 
or services.
    3. To support 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 that 
the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    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 support a CMS contractor 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, waste, or abuse in such programs.
    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, waste, 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 support 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, 
waste, or abuse in a 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,

[[Page 77762]]

remedy, or otherwise combat fraud, waste, or abuse in such programs.
    Other agencies may require FID information for the purpose of 
combating fraud, waste, and abuse in such Federally-funded programs.

B. Additional Provisions Affecting Routine Use Disclosures

    To the extent this system contains Protected Health Information 
(PHI) as defined by HHS regulation ``Standards for Privacy of 
Individually Identifiable Health Information'' (45 CFR parts 160 and 
164, subparts A and E) 65 FR 82462 (12-28-00). Disclosures of such PHI 
that are otherwise 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.'' (See 45 CFR 164-
512(a)(1)).
    In addition, our policy is to prohibit release even of not directly 
identifiable information, except pursuant to one of the routine uses or 
if required by law, if we determine 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

    CMS has safeguards in place for authorized users and monitors such 
users to ensure against unauthorized use. Personnel having access to 
the system have been trained in the Privacy Act and information 
security requirements. Employees who maintain records in this system 
are instructed not to release data until the intended recipient agrees 
to implement appropriate management, operational and technical 
safeguards sufficient to protect the confidentiality, integrity and 
availability of the information and information systems and to prevent 
unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: the Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: all pertinent National 
Institute of Standards and Technology publications; the HHS Information 
Systems Program Handbook and the CMS Information Security Handbook.

V. Effects of the Modified System of Records on Individual Rights

    CMS proposes to modify 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 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 are 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 information relating to 
individuals.

    Dated: December 19, 2006.
John R. Dyer,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NUMBER: 09-70-0527.

SYSTEM NAME:
    ``Centers for Medicare & Medicaid Services (CMS) Fraud 
Investigation Database (FID),'' HHS/CMS/OFM.

SECURITY CLASSIFICATION:
    Level Three Privacy Act Sensitive Data.

SYSTEM LOCATION:
    Centers for Medicare & Medicaid Services (CMS) Data Center, 7500 
Security Boulevard, North Building, First Floor, Baltimore, Maryland 
21244-1850, and at various other remote locations.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    Individuals alleged to have violated provision of the Act related 
to Medicare (Title XVIII), Medicaid (Title XIX), 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) OF THE SYSTEM:
    The primary purpose of the system of records is to collect and 
maintain information to: (1) Identify if a violation(s) of a provision 
of the Social Security Act (the Act) or a related penal or civil 
provision of the 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; (2) determine if HHS 
has made a proper payment as prescribed under applicable sections of 
the Act; (3) determine whether these programs have been abused; and (4) 
coordinate investigations related to Medicare, Medicaid, HMO/Managed 
Care, and Children's Health Insurance Program; (5) prevent duplications 
investigatory efforts; and (5) 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: (1) Support regulatory, reimbursement, and policy 
functions performed within the Agency or by a contractor, consultant, 
or a CMS grantee; (2) assist another Federal and/or state agency, 
agency of a state government, an agency established by state law, or 
its fiscal agent; (3) support litigation involving the Agency related 
to this system of records; and (4) combat fraud, waste, and abuse in 
certain health care programs.

[[Page 77763]]

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OR USERS AND THE PURPOSES OF SUCH USES:
    A. The Privacy Act allows 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 compatible use of data is known as a ``routine 
use.'' The proposed routine uses in this system meet the compatibility 
requirement of the Privacy Act. We are proposing to establish the 
following routine use disclosures of information maintained in the 
system:
    1. To support Agency contractors, consultants, or grantees that 
have been contracted by the Agency to assist in accomplishment of a CMS 
function relating to the purposes for this system and who need access 
to the records in order to assist CMS.
    2. To assist another Federal or state agency, agency of a state 
government, an agency established by state law, or its fiscal agent to:
    a. contribute to the accuracy of CMS's proper payment of Medicare 
benefits,
    b. 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, and/or
    c. assist Federal/state Medicaid programs within the state.
    3. To support 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 that 
the use of such records by the DOJ, court or adjudicatory body is 
compatible with the purpose for which the agency collected the records.
    4. To support a CMS contractor 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, waste, and abuse in such programs.
    5. To support 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, 
waste, and abuse in a 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, waste, and abuse in such programs.

B. Additional Provisions Affecting Routine Use Disclosures
    To the extent this system contains Protected Health Information 
(PHI) as defined by HHS regulation ``Standards for Privacy of 
Individually Identifiable Health Information'' (45 CFR parts 160 and 
164, subparts A and E) 65 FR 82462 (12-28-00). Disclosures of such PHI 
that are otherwise 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.'' (See 45 CFR 164-512 (a) 
(1)).
    In addition, our policy will be to prohibit release even of data 
not directly identifiable, except pursuant to one of the routine uses 
or if required by law, if we determine 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 could, because of the small size, use this information to 
deduce the identity of the beneficiary).

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, 
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
    All records are stored on magnetic media.

RETRIEVABILITY:
    All records are accessible by UPIN/NPI or alpha (name) search. This 
system supports both on-line and batch access.

SAFEGUARDS:
    CMS has safeguards in place for authorized users and monitors such 
users to ensure against unauthorized use. Personnel having access to 
the system have been trained in the Privacy Act and information 
security requirements. Employees who maintain records in this system 
are instructed not to release data until the intended recipient agrees 
to implement appropriate management, operational and technical 
safeguards sufficient to protect the confidentiality, integrity and 
availability of the information and information systems and to prevent 
unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations may apply but are not limited to: the Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: all pertinent National 
Institute of Standards and Technology publications; the HHS Information 
Systems Program Handbook and the CMS Information Security Handbook.

RETENTION AND DISPOSAL:
    Records are maintained for a period of 15 years. All claims-related 
records are encompassed by the document preservation order and will be 
retained until notification is received from DOJ.

SYSTEM MANAGER AND ADDRESS:
    Director, Program Integrity Group, Office of Financial Management, 
CMS, Mail Stop C3-02-16, 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

[[Page 77764]]

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 Centers for 
Medicare & Medicaid Services 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.

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.

[[Page 77765]]

    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, Administar 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.
    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. E6-22139 Filed 12-26-06; 8:45 am]
BILLING CODE 4120-03-P