By Larry Earl, MD
FMCSA Updates
In response to rising rates of fatal large truck crashes, rampant fraudulent activity around medical exams, and a damning audit from the U.S. Department of Transportation’s Office of Inspector General, the Federal Motor Carrier Safety Administration (FMCSA) has embarked on a project to rebuild and deploy a new national registry for medical examiners. The contract for the registry rebuild was awarded in December 2020 and is expected to be completed by early 2022.
An OIG audit, published in January 2021 was conducted to look at a 10.6% increase in fatalities caused by large truck and bus crashes, validate and maintain data quality in the National Registry, monitor medical examiner eligibility and performance, and review driver examinations. The audit concluded that FMCSA Has Not Fully Met Oversight Requirements as It Rebuilds the National Registry of Certified Medical Examiners. The audit was conducted during the time the national registry was offline for several months, thereby operating with limited functionality. This resulted in an as a yet unresolved backlog of some 780,000 exams potentially still missing from the registry.
Deficiencies in validating and maintaining data quality in the National Registry have impacted the monitoring of medical examiner eligibility and performance, and reviewing driver examinations.
4% of its 70,208 records of certified medical examiners as of May 2019 had outdated medical license information. Weaknesses associated with the accuracy and completeness of data in the National Registry limit the effectiveness of FMCSA’s oversight. Other findings include:
- examinations from 3 State Driver’s Licensing Agencies (SDLAs) found that 21 percent were not recorded in the National Registry.
- FMCSA has not fully implemented requirements for random periodic monitoring of medical examiners’ eligibility and performance not yet conducting annual eligibility audits after initial certification missing fraud indicators or other risks that may require mitigation less assurance that drivers are physically qualified to safely operate a commercial vehicle.
Fraud
Since August 2014, the Office of Inspector General (OIG) investigations have resulted in 14 convictions involving fraudulent medical certifications. In August 2017, a medical examiner in Georgia was charged with falsification of records with intent to impede proper administration of the Department of Transportation. 600 drivers were required to renew their medical certificates. In January 2019, a medical examiner in Alabama was sentenced to 3 years of incarceration and fined $10,000. Two employees of the practice were sentenced to 5 years of probation, revolving around a scheme to submit falsified driver examinations to the National Registry. 2,100 drivers had to renew their medical certificates. Performance Reviews The OIG found of the millions of driver examinations submitted, FMCSA had conducted only 722 performance reviews. 710 of those were for cause and only 12 were random reviews. This is in the face of having collected and analyzed data relating to pass/fail rates and detection of examiners who appear to have performed excessive numbers of examinations.
Performance Reviews
The OIG found of the millions of driver examinations submitted, FMCSA had conducted only 722 performance reviews. 710 of those were for-cause and only 12 were random reviews. This is in the face of having collected and analyzed data relating to pass/fail rates and detection of examiners who appear to have performed excessive numbers of examinations.
OIG Recommendations
Based on this audit, the OIG made several recommendations to FMCSA, and FMCSA has agreed with the recommendations as follows:
- Implement Agency plans for eliminating the backlog of driver examination results held by medical examiners.
- FMCSA is working on a plan to ensure that results of examinations conducted during the National
- Registry outages are uploaded to the National Registry
- OIG: Develop a plan to allocate resources to the Medical Programs Division to fully implement requirements for medical examiner eligibility audits and random selection performance monitoring.
- FMCSA: identified staffing and funding resources for auditing and performance monitoring that are expected to be available in FY 2022.
- OIG: Update Agency processes for conducting periodic medical examiner eligibility audits and random selection performance monitoring as needed to incorporate upgraded National Registry tools.
- FMCSA: Updated processes are being included in the rebuild of the National Registry
- OIG: Reinstate the conduct of eligibility audits and random selection performance monitoring of medical examiners.
- FMCSA: continues to conduct eligibility audits when a healthcare professional registers to become a certified ME.
- Processes are being incorporated in the rebuild of the National Registry to address eligibility audits after MEs have been certified.
- FMCSA also continues to conduct random selection performance monitoring to the extent possible without adequate staffing to do so.
- Once staffing and funding have been provided, FMCSA will reinstate its robust random selection performance monitoring.
- The medical examiner’s 5-year re-training will be pushed to after the implementation of the rebuild in 2022.
My Thoughts
The NRCME program as envisioned has failed in its mission to improve public safety through the certified examiner process. Drivers can still “game the system” and many examiners are not performing diligent exams consistent with FMCSA regulations and other best practice recommendations from multiple sources.
As an organization, NAOHP has an opportunity to create a network of certified examiners held to a more “elite status,” with ongoing training, diligent adherence to regulations and best practices, and an audit process, and be offered up to motor carriers as a more professional, risk-averse solution for their driver exams. Stay tuned to our email updates for more.
