CMS response to data breaches and medical identity theft – OIG report

The Centers for Medicare & Medicaid Services (CMS) maintains the protected health information of millions of Medicare beneficiaries. If CMS has a security breach, they’re obligated to report it just like other HITECH-covered entities. But when HHS’s Office of the Inspector General (OIG) looked at whether CMS was complying with the requirements, they found deficiencies:

CMS reported that it had 14 breaches of protected health information requiring notification under the Recovery Act between September 23, 2009, and December 31, 2011. CMS notified the 13,775 Medicare beneficiaries affected by the breaches, but did not meet several Recovery Act requirements.

Not surprisingly, perhaps, we generally do not hear about these breaches because with one exception, they each affected less than 500 people and would not appear on HHS’s breach tool. The report explains:

In general, CMS’s breaches involved beneficiaries’ names, Medicare identification numbers, dates of birth, diagnoses, and services received. In total, 13,775 Medicare beneficiaries were affected by the 14 breaches requiring notification. One breach affected 13,412 beneficiaries. This breach involved a Medicare Summary Notice printing error by a CMS contractor, which caused the notices to be sent to incorrect addresses. Ten breaches resulted from other mismailing or from loss of documents during transit. In another two breaches, beneficiary information was posted online. In the remaining breach, a CMS contractor employee was arrested for stealing beneficiary information.

Table 1 in their report provides some additional details. Although the contractor was not named, the number of affected and circumstances appear to correspond to an entry in HHS’s breach tool for Cahaba Government Benefit Administrators, LLC.

The report notes which HITECH requirements were often not met:

Although CMS notified all beneficiaries affected by the 14 breaches, it failed to meet the Recovery Act’s standard for timeliness for 7 of them. Notification letters for these breaches were not sent to the beneficiaries within the timeframe dictated by the Recovery Act (without unreasonable delay and in no case later than 60 days after the date of discovery). Notifications for some breaches were sent 4 days after the 60-day timeframe, while others were sent more than 4 months after the 60 days. Notification letters for the largest breach were sent within the required timeframe.

The notifications for these breaches often were missing required information. Notably, the notification letters for six of the breaches did not explain how the contractors were investigating the breach, mitigating losses, or protecting against further breaches, as required by the Recovery Act. Moreover, notification letters for half the breaches, including the largest breach, were missing either the date the breach occurred or the date it was discovered. Notification letters for three breaches did not include the types of unsecured protected health information involved, contact procedures for individuals who want to learn more, or steps individuals can take to protect themselves from harm.

One of the greatest areas of concern, however, is the development and use of a compromised number database for contractors. Its use could reduce the problem with medical identity theft. OIG reports:

As of February 2012, the database contained the Medicare numbers of almost 284,000 beneficiaries and 5,000 providers. The database also includes classifications that indicate the level of risk associated with each compromised number. Numbers are classified as high, medium, or low risk.23 The majority of the numbers in the database were classified as medium risk.

As noted in other media coverage this week, the government does not and will not reissue Medicare numbers to those whose numbers have been compromised. The OIG report addresses this issue as part of its discussion and recommendations on improving the use of the compromised numbers database and reducing the impact of medical identity theft for providers and beneficiaries.

You can read the full OIG report here.

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