Invalid Prescriber Identifiers on Medicare Part D Drug Claims

摘要

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established Part D to provide an optional prescription drug benefit for all Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) contracts with private companies, called plan sponsors, to administer the benefit through Part D drug plans. Part D plans must submit an electronic record, called a PDE record, to CMS for each covered prescription filled for their enrollees. CMS requires that most PDE records contain an identifier for the drug's prescriber. Acceptable prescriber identifiers include National Provider Identifiers (NPI), Drug Enforcement Administration (DEA) registration numbers, Unique Physician Identification Numbers (UPIN), and State license numbers. To determine the extent to which invalid prescriber identifiers were used on Part D claims, we compared prescriber identifiers that appeared on PDE records in 2007 to identifiers enumerated in NPI, DEA number, and UPIN registries.