President Donald Trump and his administration have been clear on their intention to crackdown on Medicare overpayments. Whether considering new legislation to help provide additional tools to go after those it believes are seeking fraudulent payments or utilizing those already available, the increased scrutiny is a reminder for medical practitioners to make sure their billing practices are above board.
Issues with billing can lead to an investigation
The United States Centers for Medicare and Medicaid Services (CMS) will move forward with an investigation if it believes your organization is using fraudulent billing practices. This investigation can include the requirement that you provide information. It is important to move forward carefully, as scammers may pose as actors on behalf of the government and attempt to steal this information.
The notice may not come directly from the government
Several government-contracted entities have the authority to determine overpayments and conduct audits. Familiarize yourself with these organizations to better identify legitimate notices:
- Recovery Audit Contractors (RACs): Tasked with identifying and correcting improper payments in Medicare.
- Medicaid Integrity Contractors (MICs): Focus on auditing Medicaid claims to ensure compliance and prevent fraud.
- Zone Program Integrity Contractors (ZPICs): Conduct investigations to detect and prevent Medicare fraud.
- Medicare Administrative Contractors (A/B/MACs): Handle claims processing and ensure adherence to Medicare policies.
Knowing these entities helps in recognizing legitimate audit notices. Each has specific roles and responsibilities, which can aid in verifying the authenticity of a notice.
Common red flags that indicate a scam
Fraudulent audit notices often contain red flags that can help you identify scams. Pay attention to the following indicators:
- Unprofessional communication: Legitimate notices are typically well-written and free of grammatical errors. Scammers may use poor language and formatting.
- Urgency and threats: Fraudulent notices often create a sense of urgency or threaten severe consequences if immediate action is not taken.
- Request for sensitive information: Be wary of notices asking for personal or financial information upfront. Legitimate audits follow a formal process. As noted above, the current scam requests such information via fax — something the CMS will not request.
- Unverified contact details: Check the contact information provided. Legitimate entities have verifiable phone numbers and addresses.
Recognizing these red flags can prevent falling victim to scams. Always verify the source and legitimacy of any audit notice before responding. You can contact your Medical Review Contractor for confirmation.
It is also important to note that you can challenge the allegations of an overpayment. There is a multi level process available that provides opportunities to hold the government accountable if they wrongly claim your organization received an overpayment.
Attorney John Rivas is responsible for this communication.
