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  Fraud and Abuse

Program Safeguard Contractors

The primary goal of the program safeguard contractor (PSC) is to:

  • identify cases of suspected fraud;
  • develop them thoroughly and in a timely manner; and
  • take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid and any mistaken payments are recouped.

National Government Services refers all suspected fraud to the PSC for additional investigation. This may include results found from provider medical review, beneficiary complaints, or through data analysis results. The PSCs responsible for National Government Services investigations are:


A/B MAC, Carrier, and Fiscal Intermediary
AdvanceMedexternal
Safeguard Services external
TrustSolutions external
   
Jurisdiction B DMEMAC
TriCenturionexternal

All fraud cases developed by the PSCs are referred to the Office of Inspector General (OIG) for consideration and initiation of criminal or civil prosecution, civil monetary penalty, or administrative sanction actions. When the PSC determines that a situation is not fraud, they refer the case back to National Government Services for additional provider education, medical review, or other appropriate action.

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Appeals
Audit & Reimbursement
Comprehensive Error Rate Testing (CERT)
Fraud & Abuse
Medical Review
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