What Is Fraud?
Fraud is the intentional deception or misrepresentation that an individual:
- knows to be false or does not believe to be true; and
- knows the deception could result in some unauthorized benefit to himself/herself or some other person.
Examples of fraudulent behavior:
- Altering claim forms to obtain a higher reimbursement amount (including billing Medicare for appointments that the patient failed to keep)
- Billing for services or supplies that were not provided (including billing for appointments beneficiaries neglected to keep)
- Billing both the beneficiary and Medicare for the same service/item
- Billing preadmission testing prior to a hospital admission that should be included in that DRG (i.e., global fee)
- Deliberately applying for duplicate reimbursement in order to get paid twice
- Completing CMN for patients not personally and professionally known by the provider
- Unbundling or “exploding” charges
- Soliciting, offering, or receiving a kickback, bribe or rebate
- False representation with respect to the nature of the services rendered or charges for such services, identity of the person receiving or rendering the services, dates of the services, etc.
- Filing claims for services that are noncovered but billed as if they were covered services
UPIC Contact Information
UPIC Western
Qlarant Integrity Solutions, LLC
Qlarant Website
States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, Utah, Washington, Wyoming
UPIC Midwestern
CoventBridge Group
CoventBridge Group Website
States: Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
UPIC Southwestern
Qlarant Integrity Solutions, LLC
Qlarant Integrity Solutions Website
States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
UPIC Northeastern
Safeguard Services, LLC
Safeguard Services Website
States: Pennsylvania, New York, Delaware, Maryland, D.C., New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Rhode Island, Connecticut
UPIC Southeastern
Safeguard Services, LLC
Safeguard Services Website
States: Alabama, Florida, Georgia, North Carolina, Puerto Rico, South Carolina, Tennessee, Virgin Islands, Virginia, West Virginia
OIG Hotline Operations
UPIC Contact Information
UPIC Western
Qlarant Integrity Solutions, LLC
Qlarant Website
States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, Utah, Washington, Wyoming
UPIC Midwestern
CoventBridge Group
CoventBridge Group Website
States: Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
UPIC Southwestern
Qlarant Integrity Solutions, LLC
Qlarant Integrity Solutions Website
States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
UPIC Northeastern
Safeguard Services, LLC
Safeguard Services Website
States: Pennsylvania, New York, Delaware, Maryland, D.C., New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Rhode Island, Connecticut
UPIC Southeastern
Safeguard Services, LLC
Safeguard Services Website
States: Alabama, Florida, Georgia, North Carolina, Puerto Rico, South Carolina, Tennessee, Virgin Islands, Virginia, West Virginia
OIG Hotline Operations
UPIC Contact Information
UPIC Western
Qlarant Integrity Solutions, LLC
Qlarant Website
States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, Utah, Washington, Wyoming
UPIC Midwestern
CoventBridge Group
CoventBridge Group Website
States: Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
UPIC Southwestern
Qlarant Integrity Solutions, LLC
Qlarant Integrity Solutions Website
States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
UPIC Northeastern
Safeguard Services, LLC
Safeguard Services Website
States: Pennsylvania, New York, Delaware, Maryland, D.C., New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Rhode Island, Connecticut
UPIC Southeastern
Safeguard Services, LLC
Safeguard Services Website
States: Alabama, Florida, Georgia, North Carolina, Puerto Rico, South Carolina, Tennessee, Virgin Islands, Virginia, West Virginia
OIG Hotline Operations
UPIC Contact Information
UPIC Western
Qlarant Integrity Solutions, LLC
Qlarant Website
States: Alaska, Arizona, American Samoa, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Marianas Islands, Oregon, South Dakota, Utah, Washington, Wyoming
UPIC Midwestern
CoventBridge Group
CoventBridge Group Website
States: Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
UPIC Southwestern
Qlarant Integrity Solutions, LLC
Qlarant Integrity Solutions Website
States: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas
UPIC Northeastern
Safeguard Services, LLC
Safeguard Services Website
States: Pennsylvania, New York, Delaware, Maryland, D.C., New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Rhode Island, Connecticut
UPIC Southeastern
Safeguard Services, LLC
Safeguard Services Website
States: Alabama, Florida, Georgia, North Carolina, Puerto Rico, South Carolina, Tennessee, Virgin Islands, Virginia, West Virginia
OIG Hotline Operations