- ABN Modifiers
- American Medical Association and Current Procedural Terminology
- CMS Forms and Publications
- CMS Regional Offices
- Clinical Lab Improvement Amendment
- Comprehensive Error Rate Testing
- Electronic Health Records
- Electronic Prescribing
- Evaluation and Management Documentation Guidelines
- Federal Register
- Health Insurance Portability and Accountability Act of 1996
- Interactive Voice Response System
- Limitation of Liability (Advance Beneficiary Notice of Noncoverage)
- Local Coverage Determination
- Medically Unlikely Edits
- Medicare Coverage Database
- Medicare Electronic Data Interchange
- Medicare Fraud and Abuse
- Medicare Learning Network®
- Medicare Provider-Supplier Enrollment with NGS
- NGS Internet Resources
- NGSConnex Online Web Application Can Save Time and Money
- NGS Check Provider Enrollment Application Status Tool
- National Correct Coding Initiative
- National Coverage Determination
- National ICD-10-CM-PCS: The Next Generation of Coding
- National Provider Calls and Events
- National Provider Identifier
- National Provider Identifier Registry
- National Uniform Claim Committee
- Open Door Forums
- P.O. Box Mailing Addresses
- Patient Protection and Affordable Care Act of 2010
- Physician Quality Payment Program
- Provider Contact Center
- Provider Enrollment
- Reconsideration (Second Level of Appeal)
- Recovery Audit Program
- Redetermination (First Level of Appeal)
- Skilled Nursing Facility Consolidated Billing
- U.S. Government Printing Office
- Washington Publishing Company
Medicare Fraud and Abuse
As the CMS MAC for J6 and JK, NGS fully supports the CMS initiative for program safeguards and shares the following information for your use:
Fraud is the intentional deception or misrepresentation that the individual knows to be false, or does not believe to be true and makes, knowing that the deception could result in some unauthorized benefit to him/herself or some other person. The most frequent line of fraud arises from a false statement or misrepresentation made, or caused to be made, that is material to entitlement or payment under the Medicare Program. Attempts to defraud the Medicare Program may take a variety of forms. Some examples include:
- Billing for services or supplies that were not provided
- Misrepresenting services rendered or the diagnosis for the patient to justify the services or equipment furnished
- Altering a claim form to obtain a higher amount paid
- Soliciting, offering, or receiving a kickback, bribe, or rebate
- Completing CMNs for patients not personally and professionally known by the provider and
- Use of another person’s Medicare card to obtain medical care
Abuse describes incidents or practices of providers that are inconsistent with accepted sound medical practices, directly or indirectly resulting in unnecessary costs to the program, improper payment for services that fail to meet professionally recognized standards of care, or services that are medically unnecessary. Abuse takes such forms as, but is not limited to:
- unbundled charges,
- excessive charges,
- medically unnecessary services and
- improper billing practices.
Although these practices may initially be considered as abuse, under certain circumstances they may be considered fraudulent. Any allegations of potential fraud or abuse should be referred appropriately:
Jurisdiction K
- ZPIC/UPIC Northeastern Safeguard Services
Jurisdiction 6
- ZPIC/UPIC Midwestern CoventBridge Group
Reporting Fraud
If you wish to report fraud, you may also contact the national OIG fraud hot line at 1-800-HHS-TIPS (1-800-447-8477). Information provided to hotline operators is sent out to state analysts and investigators.
Reward for Reporting Fraud
To be eligible for up to a $1,000 reward or 10 percent of the overpayments recovered, whichever is less, the following must be met:
- Report your fraud suspicion
- Fraud report is referred to the Office of Inspector General for review
- The fraud you report is a new case and not one already under investigation
- Your report leads to the recovery of at least $100 of Medicare money
- You are not related to people who work for certain federal agencies
Report Errors Tips Hotline
By Phone
800-HHS-TIPS (1-800-447-8477)
800-377-4950 (TTY users)
By Mail
U.S. Department of Health and Human Services
Office of Inspector General
ATTN: OIG HOTLINE OPERATIONS
P.O. Box 23489
Washington, DC 20026 3489
Internet
Office of Inspector General: Report Fraud Online
Revised 10/16/2023