[Federal Register Volume 84, Number 147 (Wednesday, July 31, 2019)]
[Notices]
[Pages 37393-37394]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-16213]


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DEPARTMENT OF VETERANS AFFAIRS


Privacy Act of 1974; Matching Program

AGENCY: Department of Veterans Affairs (VA).

ACTION: Notice of a new matching program.

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SUMMARY: In accordance with the Privacy Act of 1974, as amended, VA is 
providing notice of a new matching program between VA and the 
Department of Health and Human Services (HHS) Centers for Medicare & 
Medicaid Services (CMS) entitled ``Disclosure of Information to Support 
the Veterans Affairs' `Seek to Prevent Fraud, Waste, and Abuse 
Initiative'.''

DATES: Comments on this matching program must be received no later than 
August 30, 2019. If no public comment is received during the period 
allowed for comment or unless otherwise published in the FR by VA, the 
new Agreement will become effective a minimum of 30 days after date of 
publication in the FR. If VA receives public comments, VA shall review 
the comments to determine whether any changes to the notice are 
necessary. This matching program will be valid for 18 months from the 
effective date of this notice.

ADDRESSES: Written comments may be submitted through 
www.Regulations.gov; by mail or hand-delivery to Director, Regulation 
Policy and Management (00REG), Department of Veterans Affairs, 810 
Vermont Ave. NW, Room 1064, Washington, DC 20420; or by fax to (202) 
273-9026 (not a toll-free number). Comments should indicate that they 
are submitted in response to ``Disclosure of Information to Support the 
Veteran Affairs' Seek to Prevent Fraud, Waste, and Abuse Initiative.'' 
Copies of comments received will be available for public inspection in 
the Office of Regulation Policy and Management, Room 1063B, between the 
hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except 
holidays). Please call (202) 461-4902 for an appointment (not a toll-
free number). In addition, comments may be viewed online at 
www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Maggie Drye, Director, VA Office of 
Business Oversight Program Integrity Office, 1615 Woodward Street, 
Austin, TX 78744, (512) 386-2218.

SUPPLEMENTARY INFORMATION: This Agreement establishes the terms, 
conditions, and procedures under which CMS will provide certain data to 
VA that supports the VA's Seek to Prevent Fraud, Waste, and Abuse 
initiative. The data will be provided from CMS' database of enrolled 
Medicare providers and suppliers (System of Records Notice [SORN] No. 
09-70-0532, Provider Enrollment, Chain, and Ownership System [PECOS]). 
Using PECOS data in a matching program for this purpose will provide VA 
prompt access to extant information, using an efficient process that 
both eliminates the need to manually compare substantial numbers of 
data-intensive files and enables VA to leverage, instead of 
duplicating, the costly Advance Provider Screening process that CMS 
uses to check suitability of Medicare providers and generate the data 
in PECOS.
    Participating agencies: VA and CMS.
    Authority for conducting the matching program: This Agreement is 
executed pursuant to the Privacy Act (5 United States Code [U.S.C.] 
552a) and the regulations and guidance promulgated thereunder; Office 
of Management and Budget (OMB) Circular A-108, Federal Agency 
Responsibilities for Review, Reporting, and Publication under the 
Privacy Act, published at 81 FR 94424 (December 23, 2016); and OMB 
guidelines pertaining to computer matching published at 54 FR 25818 
(June 19, 1989). Title 38 U.S.C. 7301(b) states that the primary 
function of VA is to provide a complete medical and hospital service 
for the care of eligible Veterans. In carrying out this function, 
including through contracts with external entities and providers, VA 
has an obligation to (1) ensure providers furnish care that is 
appropriate and safe and meets or exceeds professional standards for 
quality and (2), in the case of external providers, maintain billing 
integrity and compliance with contractual terms. The VA Accountability 
First Act of 2017 provides the VA Secretary the authority to 
expeditiously remove, demote, or suspend any VA employee, including 
Senior Executive Service employees, for performance or misconduct.
    Purpose(s): Under this matching program, VA internal and external 
providers will be matched against the database of Medicare providers 
and suppliers who have been revoked by CMS pursuant to 42 Code of 
Federal Regulations (CFR) 424.535. VA intends to review the information 
provided, perform additional validation, and if deemed appropriate, 
conduct further investigation or refer the matter to the VA Office of 
the Inspector General (OIG) for further investigation. Based on 
additional validation or investigation, should VA determine VA program 
requirements have been violated, VA intends to take action (or refer to 
the OIG for action) against the VA internal and external providers. 
Such action may be based on activities that endanger VA patients and/or 
reflect improper or erroneous billing practices related to claims for 
health care provided to VA beneficiaries. Actions VA may take include 
(1) terminating or modifying existing contractual or provider 
agreements; (2) stopping referral of VA patients to the VA external 
providers; (3) referring the VA internal and external providers to the 
OIG; (4) performing pre- or post-payment reviews of claims paid or 
submitted; or (5) taking disciplinary actions or removing, demoting, or 
suspending VA internal providers.
    Categories of individuals: VA internal and external health care 
providers will be matched against the database of Medicare providers 
who have been revoked by CMS under 42 CFR 424.535.

[[Page 37394]]

``Provider'' is defined by 42 CFR 400.202 as a ``hospital, a Critical 
Access Hospital, a skilled nursing facility, a comprehensive outpatient 
rehabilitation facility, a home health agency, or a hospice that has in 
effect an agreement to participate in Medicare, or a clinic, a 
rehabilitation agency, or a public health agency that has in effect a 
similar agreement but only to furnish outpatient physical therapy or 
speech pathology services, or a community mental health center that has 
in effect a similar agreement but only to furnish partial 
hospitalization services.''
    Categories of records: VA will provide CMS electronic files, in a 
format defined by CMS, containing identifying information required to 
match VA records with CMS records. Data fields will include one or more 
of the following elements: (1) Name of Provider/Business; (2) Tax 
Identification Number (TIN) (EIN, ITIN or SSN); (3) National Provider 
Identifier (NPI); (4) State(s) in which the provider is providing 
services; and (5) Specialty Code or Taxonomy Code. Upon matching the 
TIN or NPI, CMS will provide VA the matched data elements above and the 
following additional fields: (1) NPI (for individuals) where VA 
provided a TIN; (2) Current Enrollment Status; (3) Current Enrollment 
Status Effective Date; (4) Status Reason (PECOS codes used to denote 
the specific reason(s) on which the final revocation was based); and 
(5) Flag indicating if provider has current enrollment.
    System(s) of records: VA will provide information covered by SORN 
77VA10A4, Health Care Provider Credentialing and Privileging Records-
VA, last published in full at 80 FR 36595 (June 25, 2015), Routine Uses 
No. 1 and 2; SORN 23VA10NB3, Non-VA Care (Fee) Records-VA, published at 
80 FR 45590 (July 30, 2015), Routine Use No. 2 and 30; and SORN 
02VA135, Applicants for Employment under Title 38, U.S.C.-VA, published 
at 42 FR 49728 (September 27, 1997), Routine Uses No. 1 and 2. CMS will 
provide information covered by SORN 09-70-0532, Provider Enrollment, 
Chain, and Ownership System (PECOS), last published in full at 71 FR 
60536 (October 13, 2006) and updated at 78 FR 32257 (May 29, 2013) and 
83 FR 6591 (February 14, 2018) (see Routine Use No. 2 published in 71 
FR 60536 and the unnumbered Routine Use added by 78 FR 32257); and SORN 
09-70-0555, National Plan and Provider Enumeration System, last 
published in full at 75 FR 30411 (June 1, 2010) and updated at 78 FR 
32257 (May 29, 2013) and 83 FR 6591 (February 14, 2018) (see the 
unnumbered Routine Use added by 78 FR 32257).
    The Senior Agency Official for Privacy, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. James P. 
Gfrerer, Assistant Secretary for Information and Technology and Chief 
Information Officer, Department of Veterans Affairs approved this 
document on June 28, 2019 for publication.

    Dated: July 25, 2019.
Amy L. Rose,
Program Analyst, VA Privacy Service, Department of Veterans Affairs.
[FR Doc. 2019-16213 Filed 7-30-19; 8:45 am]
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