Medicare Scam

The Indiana State Medical Association sent this recent update on the ongoing Medicare scam and a reminder to guard against identity theft

The Centers for Medicare & Medicaid Services (CMS) has become aware of a scam whereby perpetrators send faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC); the contractor for Indiana is National Government Services, Inc. (NGS).

The fax instructs physician staff to respond to a questionnaire by providing an account information update within 48 hours to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the NGS logo to enhance the appearance of authenticity.

Medicare fee-for-service providers, including physician offices, are advised to be wary. If you receive a request for information in the manner described above, please check with NGS at (866) 276-8129 and also e-mail the ISMA’s Jeri Biedenkopf or call her at (317) 454-7729, (800) 257-4762.

The bigger pictureNGS advises that a group of unknown individuals is soliciting personal identification information from physicians through various corrupt schemes. Once obtained, the personal information is being used to complete fraudulent Medicare provider applications for new practice locations.

After the new provider number is established, these individuals rapidly submit a large volume of claims to the Medicare carrier for payment.

Are you a victim and don’t know it?In one instance, a provider received a fax on what appeared to be the carrier’s letterhead. The fax, labeled “CMS File Update,” asked for documents, including copies of the physician’s medical license and driver’s license. The physician faxed the requested information to a toll-free “877” number.

The unknown party then submitted a Medicare provider application (CMS 855) under the provider’s name and set up a fake office in another city. The real physician discovered the fraud when a third-party insurer contacted him for a refund on a patient that was not his.
In another scenario, advertisements were placed in newspapers seeking resumes and other personal information. Prospective job applicants completed applications and submitted copies of medical and/or drivers’ licenses. This information was then used to establish new Medicare provider numbers and open bank accounts in the physicians’ names without their knowledge.
Protect your identity! If you recently received a phone call or fax from an alleged contractor employee asking for a “CMS File Update,” please contact the provider enrollment department immediately for verification.

If you have responded to an employment opportunity, which in retrospect seems suspicious, again contact the provider enrollment department so the information may be forwarded to the Program Safeguard contractor.

If you suspect you are the victim of provider identity theft, contact the OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477) or e-mail them.

Common sense tips:

Perform rigorous research when making application for joint venture opportunities with companies unknown to you.

Remove any unnecessary personal identifying information from outgoing correspondence.

Do not post your resume online, especially if it contains any confidential personal identifying information.

Remember no one from Medicare will contact you to verify your Medicare numbers; they already have this information.

Don’t leave laptops or other gateways into your personal information unattended.
Cancel computer access immediately when a person leaves your employment.

Perform rigorous research about a prospective employer prior to sharing any personal information.

Check with your carrier to see what practice locations are listed for you.