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Revoked Providers & Suppliers

Source: R/end-enforcement.R
revoked.Rd

Information on providers and suppliers currently revoked from the Medicare program.

Usage

revoked(
  npi = NULL,
  enid = NULL,
  first = NULL,
  last = NULL,
  org_name = NULL,
  multi = NULL,
  state = NULL,
  prov_desc = NULL,
  reason = NULL,
  start_year = NULL,
  end_year = NULL,
  count = FALSE
)

Source

Arguments

npi

<int> National Provider Identifier

enid

<chr> Medicare Enrollment ID

first, last

<chr> Individual provider name

org_name

<chr> Organization name

multi

<lgl> Provider has multiple NPIs

state

<chr> Enrollment state abbreviation

prov_desc

<chr> Provider type enrollment description

reason

<chr> Reason for revocation

start_year, end_year

<int> year of revocation/expiration

count

<lgl> Return the total row count

Value

A tibble containing the search results.

Details

The Revoked Medicare Providers and Suppliers dataset contains information on providers and suppliers who are revoked and under a current re-enrollment bar. This dataset includes provider and supplier names, NPIs, revocation authorities pursuant to 42 CFR § 424.535, revocation effective dates, and re-enrollment bar expiration dates. This dataset is based on information gathered from the Provider Enrollment, Chain and Ownership System (PECOS).

Reasons

  • § 424.535 Revocation of enrollment in the Medicare program.

    1. Noncompliance

      • Business Location Not Properly Licensed

      • Enrollment Requirements

      • Not Professionally Licensed

      • Provider/Supplier Type Requirements Not Met

        • DME Standards Not Met

        • IDTF Standards Not Met

    2. Provider Or Supplier Conduct

      • Exclusion

      • Other

    3. Felonies

    4. False Or Misleading Information

    5. On-Site Review

    6. Grounds related to provider and supplier screening requirements

    7. Misuse of billing number

    8. Abuse Of Billing Privileges

      • Pattern Or Practice

    9. Failure To Report

    10. Failure To Document

    11. Initial reserve operating funds

    12. Other Program Termination - Medicaid - Other Federal Health Care Program

    13. Prescribing Authority

    14. Improper Prescribing Practices

    15. False Claims Act (FCA)

    16. Reserved

    17. Debt Referred To Treasury

    18. Revoked Under Different Name, Numerical Identifier Or Business Identity

    19. Affiliation That Poses An Undue Risk

    20. Billing from non-compliant location

    21. Abusive ordering, certifying, referring, or prescribing of Part A or B services, items or drugs

    22. Patient Harm

    23. Violation Of Provider And Supplier Standards

Source: Code of Federal Regulations

Examples

revoked(count = TRUE)
#> ◼ revoked | 7,059 rows | 2 pages

revoked(org_name = not_blank(), count = TRUE)
#> ✔ revoked returned 3,876 results

revoked(prov_desc = contains("CARDIO"), state = excludes(c("GA", "OH")))
#> ✔ revoked returned 45 results
#> # A tibble: 45 × 11
#>    org   first   last      enid      npi multi state prov_desc reason start_date
#>    <chr> <chr>   <chr>     <chr>   <int> <int> <chr> <chr>     <chr>  <date>    
#>  1 NA    JUAN    KURDI     I2003… 1.57e9     0 TX    PRACTITI… 424.5… 2023-09-28
#>  2 NA    RONALD  CARLISH   I2003… 1.64e9     0 CA    PRACTITI… 424.5… 2022-12-13
#>  3 NA    STEVE   NOZAD     I2003… 1.96e9     0 NY    PRACTITI… 424.5… 2020-10-30
#>  4 NA    RAED    JITAN     I2004… 1.03e9     0 WV    PRACTITI… 424.5… 2020-02-14
#>  5 NA    RAYMOND CATANIA   I2004… 1.02e9     0 NJ    PRACTITI… 424.5… 2021-03-08
#>  6 NA    ROBERT  VACCARINO I2004… 1.92e9     0 NY    PRACTITI… 424.5… 2023-08-20
#>  7 NA    STEVEN  HEFTER    I2004… 1.61e9     0 AL    PRACTITI… 424.5… 2017-12-01
#>  8 NA    BRYAN   PERRY     I2004… 1.24e9     0 OK    PRACTITI… 424.5… 2020-05-21
#>  9 NA    KLAUS   RENTROP   I2005… 1.19e9     0 NY    PRACTITI… 424.5… 2023-09-15
#> 10 NA    JOHN    MCCLURE   I2005… 1.43e9     0 MI    PRACTITI… 424.5… 2022-11-02
#> # ℹ 35 more rows
#> # ℹ 1 more variable: end_date <date>