To evaluate the completeness of available data on cancer specialty, we compared the information on physician specialty contained in three data sources: (1) the Medicare claims obtained with the linked SEER-Medicare data, (2) the UPIN
Registry, and (3) the AMA Masterfile.
Brandt noted that an encrypted or password-accessed system would be necessary, given that "people have been able to get access to [the UPIN
director] who shouldn't have been able to get access to it.
To select the physician sample used in this study, pairs of terminal digits of the UPIN
were chosen randomly and then used as selection rules in drawing physicians.
They also reviewed all active UPIN
database records to identify inconsistent, missing, and questionable information.
The inspector general's report found that nearly half of the services ordered with a surrogate UPIN
either had no written order or certificate of medical necessity to support the service, or had incomplete information, such as no physician's name, signature, or description of the item.
were not used in all fraudulent cases, they were used on many occasions, Ms.
Most Common Inaccuracies in UPIN
Registry * Primary Specialty Certification 33% Secondary Specialty 23% Secondary Specialty Certification 18% Street Address of Practice Location 17% Zip Code of Practice Location 13% Professional School 11% State License Number 10% Group Practice Participation 9% Medicare Participation Status 7% Primary Specialty 5% Social Security Number 5% * Based on an analysis of practice records with errors.
The fear is that a physician's UPIN
could be given to someone who's out to defraud Medicare.
The probe found that from 2000 through 2007, Medicare paid for at least 478,500 claims that contained the UPINs
of deceased doctors.
The NPI is a HIPAA simplification standard that requires all physicians who submit electronic claims to payers to be identified by a 10-digit number that is replacing UPINs
and all other identifiers.
Physicians and other Medicare providers who are assigned PINs or UPINs
will need to obtain an NPI by the May deadline.
They will begin adopting the new universal numbers as a substitute for UPINs
and medical education numbers.