[Federal Register Volume 87, Number 63 (Friday, April 1, 2022)]
[Notices]
[Pages 19177-19178]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-06908]


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DEPARTMENT OF VETERANS AFFAIRS


Privacy Act of 1974; Matching Program

AGENCY: Department of Veterans Affairs (VA).

ACTION: Notice of a re-established matching program.

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SUMMARY: In accordance with subsection (e)(12) of the Privacy Act of 
1974, as amended, VA is providing notice of a re-established 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 
May 2, 2022. If no public comment is received during the period allowed 
for comment or unless otherwise published in the Federal Register by 
VA, the new agreement will become effective a minimum of 30 days after 
date of publication in the Federal Register. 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: Comments may be submitted through www.Regulations.gov or 
mailed to VA Privacy Service, 810 Vermont Avenue NW, (005R1A), 
Washington, DC 20420. 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.'' Comments 
received will be available at regulations.gov for public viewing, 
inspection or copies.

FOR FURTHER INFORMATION CONTACT: Maggie Drye, Director, VA Office of 
Business Oversight Program Integrity Office, 1615 Woodward Street, 
Austin, TX 78772, (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.] 
Sec.  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

[[Page 19178]]

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. ``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) All NPIs associated with a revoked TIN to include all above fields 
(1-4) and Enrollment State, Specialty, Role, Enrollment Bar status, and 
Enrollment Bar Expiration Date (if applicable).
    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 85 FR 7395 (February 7, 2020), routine 
uses 1 and 2; SORN 23VA10NB3, Non-VA Care (Fee) Records-VA, last 
published in full at 80 FR 45590 (July 30, 2015), routine use 2 and 30; 
and SORN 02VA135, Applicants for Employment under Title 38, U.S.C.-VA, 
last published in full at 42 FR 49728 (September 27, 1977), and updated 
at 51 FR 25969 (July 17, 1986), 55 FR 42534 (October 19, 1990), and 58 
FR 40852 (July 30, 1993). See routine uses 1 and 2 published at 42 FR 
49728. 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 6 published at 71 FR 60536 and the unnumbered routine use published 
at 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 routine use 5 published at 75 FR 30411 and the 
unnumbered routine use published at 78 FR 32257.

Signing Authority

    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. Joseph S. 
Stenaka, Executive Director for Information Security Operations, Chief 
Privacy Officer and Chair of the VA Data Integrity Board approved this 
document on February 17, 2022 for publication.

    Dated: March 29, 2022.
Amy L. Rose,
Program Analyst, VA Privacy Service, Office of Information Security, 
Office of Information and Technology, Department of Veterans Affairs.
[FR Doc. 2022-06908 Filed 3-31-22; 8:45 am]
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