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Provider
Enrollment Fraud Alert
This is to inform you that Medicare is aware of an
organized group who is representing themselves as either
a Medicare Fraud Investigator or a Medicare employee from
the enrollment, claims, or audit units. These callers
tell the physician or office personnel that the Medicare
computer system has had a malfunction and they need to
update lost information. The callers may also say they
need to update the physician's provider record.
They then request, via telephone or fax, the following
information:
- Copy of physician's drivers
license;
- Copy of physician's Social Security
Number (SSN);
- Unique Physician Identification Number
(UPIN);
- Verification of education;
- Verification of practice location;
- Copy of physician's medical
license;
- Copy of patient's charts for a specific
period of time.
Once the entity receives this information, they
falsify enrollment data using the physician's
name and request a change to their practice locations,
telephone numbers, and pay-to-addresses.
The Centers for Medicare & Medicaid Services (CMS)
has not suffered any computer system malfunction and are
not calling providers requesting the above information be
provided. If you should receive such a call, please try
to verify the telephone number of the caller, and
immediately notify your Medicare carrier that you suspect
fraud.
The CMS is committed to protecting all Medicare
providers/suppliers and to ensuring that only those
qualified make changes to enrollment data. We believe
that with your help we can target those unscrupulous
individuals that are looking to take advantage of you and
the Medicare trust fund.
Reference: CMS Joint Signature Memorandum,
JSM-05154
Posted: 12/27/2004
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