Deceased Practitioners Are Still in Your Directory Lists. Here’s What It Costs You.

Veritas found 19,701 deceased practitioners in the national provider registry. Social Security Administration (SSA) data, the source most organizations check against, identified only 6,475 of these deceased practioners. A gap of over 13,000 physicians may be in your current dataset if you are not using Veritas mortality data for cross validation.

That gap matters because health plans, credentialing teams, provider data companies, and state Medicaid programs all use practitioner data to decide who gets listed, credentialed and paid. If a record remains marked as active after a death has occurred, each of those decisions is made on information that is no longer true.

How Deaths Slip Through

The National Plan and Provider Enumeration System (NPPES) usually deactivates a National Provider Identifier (NPI) when someone reports the death. In practice, that means a family member, practice manager, or health system has to know a death notification step is needed and take it, however many don’t.

Directories built on NPPES carry the same mortality blind spot. When the Centers for Medicare & Medicaid Services (CMS) reviewed Medicare Advantage directories, it found providers listed who had retired or died, “sometimes years” earlier. In its 2017 to 2018 review, over 48% of sampled provider locations had at least one inaccuracy.

The base level safeguard is a check practioners against the SSA Death Master File (DMF). But as the SSA DMF is incomplete coverage, a roster can pass a SSA check and still have note captured the majority of physicians who have died.

What One Stale Record Costs

A deceased practitioner on your list rarely causes just one problem:

• Members lose trust. A directory that sends someone to a doctor who has died wastes their time and reflects on the plan, not the doctor.
• Claims get paid that shouldn’t. Claims billed under a deceased practitioner’s NPI should be stopped, but they still get through. A U.S. Senate Permanent Subcommittee on Investigations review estimated that Medicare paid $60.3 million to $92.8 million from 2000 to 2007 on durable medical equipment claims tied to deceased physicians. After payment, someone has to find each claim, recover the money and document it, and not every dollar comes back.
• Credentialing leaves a window open. A practitioner can pass primary source verification in January and die in March. If nothing changes until the next recredentialing cycle, every claim paid in between becomes a clawback.
• Data companies take the hit on accuracy. If you license practitioner data, each deceased record a customer finds before you do makes them question the rest of your file.

Regulators Expect You to Keep Up

Several rules now put directory accuracy in writing:

• The No Surprises Act requires health plans and insurers to verify their provider directories at least every 90 days.
• Under 42 Code of Federal Regulations (CFR) 455.436, state Medicaid agencies must check providers against the SSA DMF at enrollment and reenrollment.

All of these assume you can find the deaths in the first place.

Where the SSA LADMF Coverage Falls Short

To size the problem, Veritas matched every record in NPPES against its death data. Of the 19,701 deceased practitioners it found, SSA data held 6,475. For every death in SSA data, Veritas found three.

An organization relying on the SSA file alone would miss roughly two out of three of those deaths, and each one is a practitioner who can still be listed, credentialed or paid.

The number keeps moving, too. 1,626 of those practitioners, or 8.25%, died in the last 12 months.

No single source captures every death, a point we covered in more detail in Why Single-Source Mortality Data Falls Short.

Death Data You Can Defend

Finding more deaths is only useful if you trust the result enough to act. Stopping a claim or pulling a practitioner from a directory needs evidence that will hold up if someone asks. Look for death data that is:

• Multi-source. Veritas draws on 45,000+ sources rather than one state or federal file, so a gap in one source doesn’t become a gap in your results.
• Scored for confidence. Each match comes back with a match level and confidence, so your team knows which records to act on and which to review first.
• Traceable. Each match links back to the source that reported the death, which gives compliance and audit teams a clear record of why you acted.
• Timely. Veritas captures 90%+ of U.S. deaths within two weeks. For more on why lag matters, see Mortality Data Timeliness and What It Costs You to Wait.

You can run this against the data you already hold, using NPIs, names and dates of birth, or both.

Today’s Clean File Won’t Stay Clean

A one-time check tells you your list was accurate on the day you ran it. After that first check, the data begins to miss records again, at a rate of well over a hundred practitioner deaths a month nationally. Ongoing monitoring for mortality verification is the most accurate approach to keep your dataset current.

Want to stay current? First, check the list you have now. Veritas runs your practitioner roster against its death data to show where you stand today. Then we keep checking. Ongoing monitoring sends you an alert with the full date of death as new deaths come in.

If you don’t know how many deceased practitioners are on your list today, that’s the place to start.

Talk with our team about checking your dataset for deceased practioner updates.