{"id":16399,"date":"2020-09-28T17:26:48","date_gmt":"2020-09-28T17:26:48","guid":{"rendered":"http:\/\/tnmedicarehelp.com\/?page_id=16399"},"modified":"2025-01-27T16:58:31","modified_gmt":"2025-01-27T16:58:31","slug":"ucdd-home-2","status":"publish","type":"page","link":"https:\/\/tnmedicarehelp.com\/?page_id=16399","title":{"rendered":"SMP"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: left top;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#e2e2e2;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-flex-start fusion-column-no-min-height\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><style type=\"text\/css\">@media only screen and (max-width:1024px) {.fusion-title.fusion-title-1{margin-top:10px!important; margin-right:0px!important;margin-bottom:15px!important;margin-left:0px!important;}}@media only screen and (max-width:640px) {.fusion-title.fusion-title-1{margin-top:10px!important; margin-right:0px!important;margin-bottom:10px!important; margin-left:0px!important;}}<\/style><div class=\"fusion-title title fusion-title-1 fusion-title-center fusion-title-text fusion-title-size-one\" style=\"font-size:18px;margin-top:10px;margin-right:0px;margin-bottom:15px;margin-left:0px;\"><div class=\"title-sep-container title-sep-container-left\"><div class=\"title-sep sep-double sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><span class=\"awb-title-spacer\"><\/span><h1 class=\"title-heading-center\" style=\"margin:0;font-size:1em;\"><div id=\"pg-34-0\" class=\"panel-grid panel-has-style\" data-style=\"{\">\n<div class=\"panel-row-style panel-row-style-for-34-0\">\n<div id=\"pgc-34-0-0\" class=\"panel-grid-cell\" data-weight=\"1\"><span style=\"font-family: 'Bebas Neue'; font-weight: 400; font-size: 35px;\" data-fusion-font=\"true\" data-fusion-google-font=\"Bebas Neue\" data-fusion-google-variant=\"400\">Together, we can make a difference<\/span><br \/><span style=\"font-family: Roboto; font-weight: 400;\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"><br \/><\/span><\/div>\n<div id=\"pgc-34-0-0\" class=\"panel-grid-cell\" data-weight=\"1\"><span style=\"font-family: Roboto; font-weight: 400;\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Empowering Seniors to Prevent Medicare &amp; Medicaid Fraud, offers assistance in educating beneficiaries on identifying and preventing Medicare and Medicaid fraud, waste and abuse. Upper Cumberland Development District (UCDD) received the grant to administer the SMP program in 2001. The grant is funded in part by Administration on Community Living. Prior to January 2006, the program name was Senior Medicare Patrol Project.<\/span><\/div>\n<\/div>\n<\/div>\n<p>\u00a0<\/p>\n<p>\u00a0<\/p><\/h1><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container title-sep-container-right\"><div class=\"title-sep sep-double sep-solid\" style=\"border-color:#e2e2e2;\"><\/div><\/div><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-0{width:100% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-0 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-0{width:100% !important;}.fusion-builder-column-0 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-0{width:100% !important;}.fusion-builder-column-0 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-1{ padding-top : 20px;margin-top : 0px;padding-right : 0px;padding-bottom : 20px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#e2e2e2;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-flex-start fusion-column-no-min-height\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-blend-mode: overlay;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><div class=\"fusion-section-separator section-separator triangle fusion-section-separator-1\"><div class=\"fusion-section-separator-svg\" style=\"border-bottom:1px solid #ffffff;\"><div class=\"divider-candy-arrow bottom\" style=\"top:0px;border-top-color: #ffffff;\"><\/div><div class=\"divider-candy bottom\" style=\"bottom:-21px;border-bottom:1px solid #ffffff;border-left:1px solid #ffffff;\"><\/div><\/div><div class=\"fusion-section-separator-spacer\"><div class=\"fusion-section-separator-spacer-height\" style=\"height:1px;\"><\/div><\/div><style type=\"text\/css\">.fusion-section-separator-1 .fusion-section-separator-svg {margin-left:1.92%;margin-right:1.92%;}@media only screen and (max-width:1024px) {.fusion-section-separator-1 .fusion-section-separator-svg {margin-left:1.92%;margin-right:1.92%;}}@media only screen and (max-width:640px) {.fusion-section-separator-1 .fusion-section-separator-svg {margin-left:1.92%;margin-right:1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-1{width:100% !important;margin-top : 0px;margin-bottom : 0px;}.fusion-builder-column-1 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-1{width:100% !important;}.fusion-builder-column-1 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-1{width:100% !important;}.fusion-builder-column-1 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-fullwidth.fusion-builder-row-2 { overflow:visible; }.fusion-body .fusion-flex-container.fusion-builder-row-2{ padding-top : 0px;margin-top : 0px;padding-right : 30px;padding-bottom : 0px;margin-bottom : 0px;padding-left : 30px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: #3b4552;background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#e2e2e2;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-center fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><style type=\"text\/css\">@media only screen and (max-width:1024px) {.fusion-title.fusion-title-2{margin-top:10px!important; margin-right:0px!important;margin-bottom:15px!important;margin-left:0px!important;}}@media only screen and (max-width:640px) {.fusion-title.fusion-title-2{margin-top:10px!important; margin-right:0px!important;margin-bottom:10px!important; margin-left:0px!important;}}<\/style><div class=\"fusion-title title fusion-title-2 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"font-size:35px;margin-top:10px;margin-right:0px;margin-bottom:15px;margin-left:0px;\"><h1 class=\"title-heading-center\" style=\"margin:0;font-size:1em;\"><span style=\"color: rgb(255, 255, 255); font-family: 'Bebas Neue'; font-weight: 400;\" data-fusion-font=\"true\" data-fusion-google-font=\"Bebas Neue\" data-fusion-google-variant=\"400\">Fraud and Abuse<\/span><\/h1><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><\/div><div class=\"fusion-text fusion-text-1\" style=\"color:var(--awb-color1);\"><p><img decoding=\"async\" class=\"size-medium wp-image-16357 alignleft\" src=\"https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/shutterstock_236125216-768x512-1-300x200.jpg\" alt=\"\" width=\"300\" height=\"200\" srcset=\"https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/shutterstock_236125216-768x512-1-200x133.jpg 200w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/shutterstock_236125216-768x512-1-300x200.jpg 300w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/shutterstock_236125216-768x512-1-400x267.jpg 400w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/shutterstock_236125216-768x512-1-600x400.jpg 600w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/shutterstock_236125216-768x512-1.jpg 768w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><span style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">The types of schemes that can and are being perpetrated against the health care system are as complex as the system itself. Common fraud schemes include efforts to fraudulently obtain and use a person\u2019s Medicare number, as well as scams that specifically target Medicare services and plans.<\/span><\/p>\n<p style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">If you are not receiving Social Security benefits, you will need to contact your local Social Security office and sign up for Part A. Three months before you turn 65, you need to contact your local Social Security office. You can also buy Part A during the following times, if you are not eligible for premium-free Part A: Initial Enrollment Period (three months before and three months after you turn 65), Special Enrollment Period (if you or your spouse is working and has insurance through your employer), and Special Enrollment Period for International Volunteers (if you are serving as a volunteer in a foreign country).<\/p>\n<p style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">CMS contracts with outside companies to review medical claims, pay bills, and examine medical claims for patterns of inappropriate billing. These contractors use many techniques to identify potential payment issues and verify that the same mistakes are not repeated. Providers can be required to have every one of their claims examined before payment is made to ensure that abuse practices do not continue. On-site audits can be conducted and examiners can speak to beneficiaries and examine medical records to make sure that services billed to Medicare were the same services actually received.<\/p>\n<p><span style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Medicare fraud is defined as <\/span><strong style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">knowingly<\/strong><span style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> and <\/span><strong style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">willfully<\/strong><span style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> executing, or attempting to execute, a scheme or ploy to defraud the Medicare program, or obtaining information by means of false pretenses, deception, or misrepresentation in order to receive inappropriate payment from the Medicare program.<\/span><\/p>\n<p style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">The most frequent kind of fraud arises from a false statement or misrepresentation that is relevant to entitlement or payment under the Medicare program.<\/p>\n<p style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">CMS (Centers for Medicare &amp; Medicaid Services) documents formally define fraud as \u201cthe intentional deception or misrepresentation that the individual knows to be false or does not believe to be true, and the individual makes knowing that the deception could result in some unauthorized benefit to himself or herself or some other person.\u201d<\/p>\n<p style=\"font-family: Roboto; font-size: 18px;\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"><b style=\"color: var(--awb-color1);\">Fraud can be committed by any of the following people or groups:<\/b><\/p>\n<ul>\n<li><span style=\"color: var(--awb-color1); font-family: Roboto; font-size: 18px; font-style: var(--body_typography-font-style,normal); letter-spacing: var(--body_typography-letter-spacing);\">Physicians or other health care practitioners<\/span><\/li>\n<li><span style=\"color: var(--awb-color1); font-family: Roboto; font-size: 18px; font-style: var(--body_typography-font-style,normal); letter-spacing: var(--body_typography-letter-spacing);\">Suppliers of durable medical equipment<\/span><\/li>\n<li><span style=\"color: var(--awb-color1); font-family: Roboto; font-size: 18px; font-style: var(--body_typography-font-style,normal); letter-spacing: var(--body_typography-letter-spacing);\">An employee of a physician or supplier<\/span><\/li>\n<li><span style=\"color: var(--awb-color1); font-family: Roboto; font-size: 18px; font-style: var(--body_typography-font-style,normal); letter-spacing: var(--body_typography-letter-spacing);\">An employee of the companies that manage Medicare billing<\/span><\/li>\n<li><span style=\"color: var(--awb-color1); font-family: Roboto; font-size: 18px; font-style: var(--body_typography-font-style,normal); letter-spacing: var(--body_typography-letter-spacing);\">A billing service<\/span><\/li>\n<li><span style=\"color: var(--awb-color1); font-family: Roboto; font-size: 18px; font-style: var(--body_typography-font-style,normal); letter-spacing: var(--body_typography-letter-spacing);\">A beneficiary<\/span><\/li>\n<li><span style=\"color: var(--awb-color1); font-family: Roboto; font-size: 18px; font-style: var(--body_typography-font-style,normal); letter-spacing: var(--body_typography-letter-spacing);\">Any other person or business in a position to bill the Medicare program or to benefit from Medicare being billed<\/span><\/li>\n<\/ul>\n<p><strong style=\"font-family: Roboto; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Examples of Medicare Fraud<\/strong><\/p>\n<ul>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> Billing for services or supplies that were not provided<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> Altering claim forms to obtain a higher payment amount<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing twice for the same service or item<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing separately for services that should be included in a single service fee<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Misrepresenting the diagnosis to justify payment<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> Continuing to bill for services or items no longer medically necessary<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing for rental equipment after date of return<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing \u201cnon-covered\u201d services or items as \u201ccovered\u201d services<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Ordering unnecessary lab tests<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Refusing to bill Medicare for covered services or items<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Using another person&#8217;s Medicare card to obtain medical care<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Soliciting, offering, or receiving a kickback, bribe, or rebate (for example, paying for referrals of patients)<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Completing a Certificate of Medical Necessity (CMN) for a patient not professionally known by the provider<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Completing a CMN when not authorized (for example, a supplier completing a CMN for the physician)<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Signing authorizations for medical equipment or procedures that are not medically necessary<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Waiving co-insurance or deductible<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing for home health care services for patients who do not meet the requirement of \u201chomebound\u201d status<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Using unethical or unfair marketing strategies, such as offering beneficiaries free groceries or transportation to switch providers<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing social activities as psychotherapy<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing group services as individual services for each patient in the group<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Repeatedly violating the participation agreement, assignment agreement, or limiting charge<\/span><\/li>\n<li><span class=\"listColor\" style=\"font-family: Roboto; font-weight: 400; font-size: 18px; color: var(--awb-color1);\" data-fusion-font=\"true\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Outpatient hospital services provided within 72 hours of surgery or other inpatient procedure (known as \u201cthe 72-hour rule\u201d)<\/span><\/li>\n<\/ul>\n<\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-2{width:100% !important;margin-top : 0px;margin-bottom : 20px;}.fusion-builder-column-2 > .fusion-column-wrapper {padding-top : 0px !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-2{width:100% !important;}.fusion-builder-column-2 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-2{width:100% !important;}.fusion-builder-column-2 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-3{ padding-top : 100px;margin-top : 0px;padding-right : 0px;padding-bottom : 100px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-4 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: #72869e;background-position: center center;background-repeat: repeat;border-width: 0px 0px 0px 0px;border-color:#e2e2e2;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 70px 0px 20px 0px;\"><style type=\"text\/css\">@media only screen and (max-width:1024px) {.fusion-title.fusion-title-3{margin-top:20 px!important; margin-right:0px!important;margin-bottom:20 px!important;margin-left:0px!important;}}@media only screen and (max-width:640px) {.fusion-title.fusion-title-3{margin-top:10px!important; margin-right:0px!important;margin-bottom:10px!important; margin-left:0px!important;}}<\/style><div class=\"fusion-title title fusion-title-3 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"font-size:35px;margin-top:20px px;margin-right:0px;margin-bottom:20px px;margin-left:0px;\"><h1 class=\"title-heading-center\" style=\"margin:0;font-size:1em;color:var(--awb-color1);\"><strong style=\"font-family: 'Bebas Neue'; font-weight: 400;\" data-fusion-font=\"true\" data-fusion-google-font=\"Bebas Neue\" data-fusion-google-variant=\"400\">Definition of Medicare Abuse<\/strong><\/h1><\/div><div class=\"fusion-text fusion-text-2\" style=\"color:#ffffff;\"><p><span data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Medicare Abuse is defined as incidents or practices of providers that are inconsistent with accepted sound <\/span><img decoding=\"async\" class=\" wp-image-16359 alignright\" src=\"https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/AdobeStock_66657478-768x512-1-300x200.jpeg\" alt=\"\" width=\"317\" height=\"211\" srcset=\"https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/AdobeStock_66657478-768x512-1-200x133.jpeg 200w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/AdobeStock_66657478-768x512-1-300x200.jpeg 300w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/AdobeStock_66657478-768x512-1-400x267.jpeg 400w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/AdobeStock_66657478-768x512-1-600x400.jpeg 600w, https:\/\/tnmedicarehelp.com\/wp-content\/uploads\/2020\/09\/AdobeStock_66657478-768x512-1.jpeg 768w\" sizes=\"(max-width: 317px) 100vw, 317px\" \/><span data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">medical, business, or fiscal practices. These practices may directly or indirectly result in unnecessary costs to the program, improper payment, or payment for services that fail to meet professionally recognized standards of care, or that are medically unnecessary. The CMS definition of abuse is: \u201cBilling Medicare for services that are not covered or are not correctly coded.\u201d Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not <\/span><strong data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">knowingly<\/strong><span data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> and <\/span><strong data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">intentionally<\/strong><span data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> misrepresented the facts to obtain payment.<\/span><\/p>\n<p><strong data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Examples of Medicare Abuse<\/strong><\/p>\n<ul>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\"> Excessive charges for services or supplies<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Routinely submitting duplicate claims<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Improper billing practices such as:<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Exceeding the limiting charge<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Billing Medicare at a higher fee schedule rate than for non-Medicare patients<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Submitting bills to Medicare when Medicare is not the beneficiary\u2019s primary insurer<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Collecting more than 20% coinsurance or the deductible on claims filed with Medicare<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Breach of the Medicare participation or assignment agreements<\/span><\/li>\n<li><span class=\"listColor\" data-fusion-font=\"true\" style=\"font-size: 18px; font-family: Roboto; font-weight: 400; color: var(--awb-color1);\" data-fusion-google-font=\"Roboto\" data-fusion-google-variant=\"400\">Claims for services that are not medically necessary<\/span><\/li>\n<\/ul>\n<\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-3{width:100% !important;margin-top : 0px;margin-bottom : 20px;}.fusion-builder-column-3 > .fusion-column-wrapper {padding-top : 70 !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 20 !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-3{width:100% !important;}.fusion-builder-column-3 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-3{width:100% !important;}.fusion-builder-column-3 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-4{ padding-top : 0px;margin-top : 0px;padding-right : 0px;padding-bottom : 70px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-5 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#e2e2e2;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-stretch\" style=\"max-width:1144px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_1 1_1 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><style type=\"text\/css\">@media only screen and (max-width:1024px) {.fusion-title.fusion-title-4{margin-top:0px!important; margin-right:0px!important;margin-bottom:15px!important;margin-left:0px!important;}}@media only screen and (max-width:640px) {.fusion-title.fusion-title-4{margin-top:10px!important; margin-right:0px!important;margin-bottom:10px!important; margin-left:0px!important;}}<\/style><div class=\"fusion-title title fusion-title-4 fusion-sep-none fusion-title-center fusion-title-text fusion-title-size-one\" style=\"font-size:45px;margin-top:0px;margin-right:0px;margin-bottom:15px;margin-left:0px;\"><h1 class=\"title-heading-center\" style=\"margin:0;font-size:1em;color:var(--awb-color6);\"><span style=\"color: #003366; font-family: 'Bebas Neue'; font-weight: 400;\" data-fusion-font=\"true\" data-fusion-google-font=\"Bebas Neue\" data-fusion-google-variant=\"400\">suspect Medicare Fraud? call us at:<\/span><a href=\"tel:1-866-836-7677\"><span style=\"color: #003366; font-family: 'Bebas Neue'; font-weight: 400;\" data-fusion-font=\"true\" data-fusion-google-font=\"Bebas Neue\" data-fusion-google-variant=\"400\">1-866-836-7677<\/span><\/a><\/h1><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-builder-column-4{width:100% !important;margin-top : 0px;margin-bottom : 20px;}.fusion-builder-column-4 > .fusion-column-wrapper {padding-top : 0 !important;padding-right : 0px !important;margin-right : 1.92%;padding-bottom : 0px !important;padding-left : 0px !important;margin-left : 1.92%;}@media only screen and (max-width:1024px) {.fusion-body .fusion-builder-column-4{width:100% !important;}.fusion-builder-column-4 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}@media only screen and (max-width:640px) {.fusion-body .fusion-builder-column-4{width:100% !important;}.fusion-builder-column-4 > .fusion-column-wrapper {margin-right : 1.92%;margin-left : 1.92%;}}<\/style><\/div><\/div><style type=\"text\/css\">.fusion-body .fusion-flex-container.fusion-builder-row-5{ padding-top : 100px;margin-top : 0px;padding-right : 0px;padding-bottom : 100px;margin-bottom : 0px;padding-left : 0px;}<\/style><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":[],"_links":{"self":[{"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=\/wp\/v2\/pages\/16399"}],"collection":[{"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16399"}],"version-history":[{"count":18,"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=\/wp\/v2\/pages\/16399\/revisions"}],"predecessor-version":[{"id":16558,"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=\/wp\/v2\/pages\/16399\/revisions\/16558"}],"wp:attachment":[{"href":"https:\/\/tnmedicarehelp.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16399"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}