While working with the Center for M...

While working with the Center for Medicare and Medicaid Services (CMS) the California Benefit Integrity Support Center discovered a fraud scheme. Fraudulent employer tender con-tracts to physicians for reviewing charts, interpreting standards or supervising clinical staff and operations. Their goal is to obtain the physician Medicare provider identification numbers (PINs), for a like reason they can submit multiple claims for individual patient. According to the notice, these fraudulent employer recruit health professionals within residency programs, by word of chaps or advertisements in newspapers. They present a percentage or a monthly or annual unconditional tenure for physician services. In exchange, the physicians are asked to sign a contract allowing the use of the physician's PIN and making the physician the billing provider for the clinic. Another option is opening a joint bank account for Medicare reimbursements to which the fraudulent employer has direct access. CM will demand repayment from the physician for fraudulent claims upon that PIN, and the physician could be prosecut for fraud. More information is available online at http://www.aafp.org/x28200.xml. Information about Medicare fraud, tips for recognizing it, and ways of reporting it are provided by way of CMS online at http://www.cms.hhs.gov/providers/fraud.

COPYRIGHT 2004 American Academy of Family Physicians

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