• Becky Amann

Medicare fraud costs the U.S. hundreds of millions of dollars each year

Medicare fraud costs the United States government hundreds of millions of dollars each year. CMS works with other government agencies and law enforcement organizations to protect the Medicare Program from fraud and abuse. Zone Program Integrity Contractors (ZPIC’s) and Unified Program Integrity Contractors (UPIC’s) investigate instances of suspected fraud, waste and abuse.

Their primary goals include:

  • Develop investigations early and in a timely manner.

  • Take immediate action to ensure the Medicare Trust Fund monies are not inappropriately paid.

  • Identify any improper payments that are to be recouped by Medicare carriers, Fiscal Intermediaries (FI’s) and Medicare Administrative Contractors (MAC’s).

Your UPIC contractor is Safeguard Services, LLC and National Government Services (NGS), is your MAC. Both cover NYS and Connecticut, as well as other states. NGS refers all suspected fraud to Safeguard Services, LLC for additional investigation.

This may include results found from:

  • Provider medical reviews

  • Beneficiary complaints

  • Data Analysis.

Some examples of fraud include:

  • Altering claim forms to obtain a higher reimbursement amount (including billing Medicare for appointments that the patient failed to keep).

  • Filing claims for services that are noncovered but billed as if they were covered services.

Some examples of abuse include:

  • Claims for services not medically necessary (to the extent furnished).

  • Routine waiver of coinsurance and deductibles.

For Compliance questions, please contact Becky Amann at 716-389-3202 or beckya@pracfirst.com.

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