SYSTEM NAME:
Office of Workers' Compensation Programs, Physicians and Health Care Providers Excluded under the Energy Employees Occupational Illness Compensation Program Act.
SECURITY CLASSIFICATION:
None.
SYSTEM LOCATION:
At component agency national, district, and contractor offices.
CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
Providers of medical goods and services, including physicians, hospitals, and providers of medical support services or supplies excluded or considered for exclusion from payment under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) for fraud or abuse (20 CFR § 30.715-30.726, or as updated).
CATEGORIES OF RECORDS IN THE SYSTEM:
Copies of letters, lists and documents from Federal and State agencies concerning the administrative debarment of providers from participation in programs providing benefits similar to those of the EEOICPA and their reinstatement; material concerning possible fraud or abuse which could lead to exclusion of a provider; documents relative to reinstatement of providers, materials concerning the conviction of providers for fraudulent activities in connection with any Federal or State program for which payments are made to providers for similar medical services; all letters, memoranda, and other documents regarding the consideration of a provider's exclusion, the actual exclusion, or reinstatement under the provisions of 20 CFR § 30.715-30.726 (or as updated); copies of all documents in a claim file relating to medical care and/or treatment including bills for such services, as well as letters, memoranda, and other documents obtained during investigations, hearings and other administrative proceedings concerning exclusion for fraud or abuse, as well as reinstatement, along with recommendations and decisions; lists of excluded providers released by OWCP.
AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
Energy Employees Occupational Illness Compensation Program Act of 2000, Title XXXVI of Public Law 106-398, October 30, 2000, 114 Stat. 1654, and as amended.
PURPOSE(S):
To maintain records in order to determine the propriety of instituting debarment actions under EEOICPA. These records also provide information regarding treatment, billing and other aspects of a medical provider's actions, and/or documentation relating to the debarment of the medical care provider under another Federal or State program.
ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES OF USERS AND THE PURPOSES OF SUCH USES:
In addition to the universal routine uses listed in the General Prefatory Statement to this document, the disclosure of information from this system of records may be made to the following individuals and entities for the purposes noted when the purpose of the disclosure is compatible with the purpose for which the information is collected:
a. Federal, State or local government agencies, State licensing boards, professional organizations, claimants, patients, employers, insurance companies, and any other entities or individuals, for the purpose of identifying an excluded or reinstated provider to ensure that authorization is not issued nor payment made to an excluded provider, and for the purpose of providing notice that a formerly excluded provider has been reinstated.
b. Federal, State or local government agencies, State licensing boards, professional organizations, claimants, patients, employers, insurance companies, and any other entities or individuals, for the purpose of obtaining information necessary to ensure that the list of excluded providers is correct, useful, and updated, as appropriate, and for the purpose of obtaining information relevant to a Departmental decision regarding a debarment action. This routine use encompasses the disclosure of such information that will enable the Department to properly verify the identity of a provider, to identify the nature of a violation, and the penalty imposed for such violation.
Note: Disclosure of information contained in the file to the claimant, a person who is duly authorized to act on his/her behalf, or to others to whom disclosure is authorized by these routine uses, may be made over the telephone. Disclosure over the telephone will only be done where the requestor provides appropriate identifying information. Telephonic disclosure of information is essential to permit efficient administration and adjudication of claims.
DISCLOSURE TO CONSUMER REPORTING AGENCIES:
None.
POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
Files are stored electronically and/or in paper form.
RETRIEVABILITY:
Files are retrieved either by the name of the provider, case citation, or date of release.
SAFEGUARDS:
Access by authorized personnel only. Computer security safeguards are used for electronically stored data and locked locations for paper files.
RETENTION AND DISPOSAL:
Specific electronic data tables received from the Department of Health and Human Services (HHS) should be deleted from the server when HHS advises that the period of exclusion has expired due to reinstatement. The Master file is maintained in a separate file on the National Office server and they are to be destroyed when they are no longer needed. Hard copies of reports are to be destroyed when new reports are generated. In-house exclusions and correspondence files are retained until debarment action is finalized and then transferred to the Federal Records Center at the end of the fiscal/annual year, and destroyed 30 years after the date of final debarment action. Documentation relating to a master file, database and other electronic records are destroyed or deleted upon authorized deletion of the related electronic records or upon the destruction of the output of the system if the output is needed to protect legal rights, whichever is later.
SYSTEM MANAGER(S) AND ADDRESS:
Director for Energy Employees Occupational Illness Compensation, Office of Workers' Compensation Programs, 200 Constitution Avenue, N.W., Washington D.C. 20210.
NOTIFICATION PROCEDURE:
An individual wishing to inquire whether this system of records contains information about him/her may write to the system manager at the address above. In order for the record to be located, the individual must provide his or her full name, date of birth, and signature.
RECORD ACCESS PROCEDURES:
Any individual seeking access to non-exempt information about a record within this system of records may write the system manager, and arrangements will be made to provide review of the file. In order for the record to be located, the individual must provide his or her full name, date of birth, and signature.
CONTESTING RECORD PROCEDURES:
A petition for amendment should be mailed to the System Manager.
RECORD SOURCE CATEGORIES:
Information in this system is obtained from Federal, State or local government agencies, state licensing boards, professional organizations, claimants, patients, employers, insurance companies, any other entities or individuals, public documents, and newspapers, as well as from other Department systems of records.
SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
In accordance with 5 U.S.C. 552a(k)(2), investigatory material compiled for law enforcement purposes which is maintained in the investigation files of OWCP, is exempt from subsections (c)(3), (d), (e)(1), (e)(4)(G), (H), and (I), and (f) of 5 U.S.C. 552a. The disclosure of information contained in civil investigative files, including the names of persons and agencies to which the information has been transmitted, would substantially compromise the effectiveness of the investigation. Knowledge of such investigations would enable subjects to take such action as is necessary to prevent detection of illegal activities, conceal evidence or otherwise escape civil enforcement action. Disclosure of this information could lead to the intimidation of, or harm to, informants and witnesses, and their respective families, and the wellbeing of investigative personnel and their families.