{
  "slug": "nh-hospice-hh-ownership-flags",
  "title": "Nursing home, hospice, home health, hospital owners on federal exclusion lists",
  "hypotheses": [
    "H35"
  ],
  "status": "published",
  "release_date": "CMS Quarterly All Owners + PPEF (both 2026-04-01)",
  "generated_at": "2026-05-14T23:47:28+00:00",
  "methodology_version": "0.6.1-draft",
  "commit_sha": "bdaceab",
  "data_confidence": "two-tier",
  "data_confidence_note": "Two-tier methodology (Stage B, 0.6.1-draft). Tier 1 (confirmed_npi, 0 rows): NPI-keyed match via CMS Medicare Fee-For-Service Public Provider Enrollment File (ASSOCIATE ID - OWNER \u2192 PECOS_ASCT_CNTL_ID \u2192 NPI), checked against LEIE.NPI and SAM.npi. Authoritative \u2014 same NPI, same person. Tier 2 (candidate_demographic, 1,779 rows): (LAST_NAME, FIRST_NAME, FACILITY_STATE) match against LEIE. Facility state used because owner-side state is structurally empty for individual owners in the All Owners files. Carries known false-positive risk; published as a verification surface, NOT a fraud determination.",
  "headline": "AINPI identifies 1779 CANDIDATE-DEMOGRAPHIC matches and 0 CONFIRMED-NPI matches between owners of Medicare-enrolled SNFs, hospices, home health agencies, and hospitals (CMS All Owners 2026-04-01) and OIG LEIE active exclusions. Tier 1 (NPI-keyed) returns 0 because exclusion forces Medicare revocation \u2014 only 25 of 8,619 LEIE\u222aSAM-active NPIs are still in the CMS PPEF cross-walk, and none of those 25 are listed as owners. Tier 2 ((LAST, FIRST, FACILITY_STATE) demographic match) surfaces 1779 candidate rows: 17 are VA-state facilities. Skilled Nursing Facilities: 0 confirmed / 716 candidate; Hospices: 0 confirmed / 226 candidate; Home Health Agencies: 0 confirmed / 322 candidate; Hospitals: 0 confirmed / 515 candidate. Every candidate row must be verified against the LEIE portal before any state survey agency action.",
  "numerator": 0,
  "numerator_full_window": 1779,
  "denominator": null,
  "numerator_note": "Headline numerator = confirmed_npi tier only (0). Full-window numerator (confirmed + candidate) = 1779.",
  "denominator_note": "Denominator is not pinned because the All Owners files are owner-record-level (multiple rows per owner if they hold interests in multiple facilities). Reach context: 444,106 individual-owner rows scanned across 4 facility types; PPEF ENRLMT_ID \u2192 STATE lookup hits 100% of those rows (facility state always resolved). LEIE active demographic keys = 78,688; LEIE NPI-populated = 8,608; SAM-active with NPI = 4,707. Tier 1 ceiling is bounded by the 25 LEIE\u222aSAM-active NPIs still in PPEF (most excluded providers are revoked and therefore not in PPEF).",
  "data_source_release": "CMS Quarterly All Owners + PPEF (both 2026-04-01)",
  "data_source_url": "https://data.cms.gov/provider-characteristics",
  "chart": {
    "type": "bar",
    "unit": "count",
    "data": [
      {
        "label": "Confirmed-NPI matches",
        "value": 0
      },
      {
        "label": "Candidate-demographic matches",
        "value": 1779
      }
    ]
  },
  "notes": "Stage B methodology (0.6.1-draft) introduces NPI-keyed matching via the CMS PPEF (Medicare Fee-For-Service Public Provider Enrollment File, 2026-04-01). PPEF publishes NPI \u2194 PECOS_ASCT_CNTL_ID for 2.47M individual NPIs; the All Owners files publish ASSOCIATE ID - OWNER (same identifier space) for every individual-owner record. Two source-data-shape facts drive the tier design: (1) CMS does NOT populate STATE - OWNER for individuals (100% empty in the 2026-04-01 release) \u2014 the v1 demographic match joined on this empty field and therefore produced a structural-null result. Stage B substitutes the facility's STATE_CD (resolved via PPEF ENRLMT_ID, 100% lookup hit). (2) Exclusion under 42 USC \u00a7 1320a-7 forces revocation of Medicare enrollment, so most excluded NPIs are not in PPEF (25 of 8,619 LEIE\u222aSAM-active NPIs remain in PPEF \u2014 likely recent exclusions not yet processed out). Tier 1 is therefore inherently small-N; the null is itself evidence that CMS's exclusion-revocation pipeline is working. Per-state CSV at /api/v1/states/va/h35-nh-ownership-flags.csv carries both tiers with match_tier column."
}