News and Updates >> Client Update
February 9, 2005
Provider Enrollment Fraud Alert
PhyLogic has been made aware by Medicare that there is an organized group attempting to fraudulently
obtain physician information in an effort to receive Medicare payments illegally. While no PhyLogic clients
have been the target of such a group, we feel it important to provide clients with this information so that
they may educate themselves on how to spot, and therefore prevent, any such incidences.
How it works…
The perpetrators contact the medical office representing themselves as either a Medicare fraud investigator
or a Medicare representative in the provider enrollment, claim or audit units. The callers often
claim to the physician or their staff that the Medicare/CMS has had a computer system malfunction
and they need to update lost information. They then make an effort to obtain physician information
needed to commit their fraudulent acts.
It is important to note that CMS has not suffered any computer system malfunction and they are
not calling providers for missing provider information.
Providers and their office staff should therefore pay particular attention to any
callers who may be asked for physician information such as:
- Copies of a driver’s license
- Physician's social security number
- Physician UPIN number
- Verification of Education
- Copy of a medical license
If you receive a call and suspect fraud, it is asked that you try and verify the telephone/fax number of the caller and then contact CMS immediately at 1-866-535-6790, so that they can investigate the matter. After doing so, please contact your PhyLogic Reimbursement Specialist and inform them of the situation so that they are alerted to the situation and can take appropriate action.