The Centers for Medicare & Medicaid Services (CMS) has been made aware of a scheme involving faxes sent to providers demanding all patient information and medical records for Medicare patients.
This alert serves as notification of potentially inappropriate requests being sent to providers.
What to look for:
These requests include verbiage demanding information within a 72-hour deadline. These demand requests appear to include CMS headers for authenticity. Other examples include a header for National Archives and Records Administration (NARA).
Please see an example cover sheet in the Image below. CMS reminds providers that medical record reviews requested by CMS or their contractors will identify specific Medicare beneficiaries, time periods, and encounters or prescription drug event records involved.
These requests also provide ample time (typically 30- 45 days) for response. Medicare medical reviews are requested through an Additional Documentation Request.
Allegations of suspected Medicare fraud schemes can be made to Medicare by calling 1-800-MEDICARE (1-800-633-4227) or online at https://oig.hhs.gov/fraud/report-fraud/.
Any suspected fraud schemes involving CHPW Medicare members can also be reported to CHPW’s Fraud, Waste, and Abuse program via email at [email protected].
What kind of care do you need? Not every medical issue needs emergency care. If you have a medical issue that doesn’t seem to be life-threatening, but you’re not sure what to do, see if your local Community Health Center clinic or primary care doctor offers virtual care. If they do, they will tell you how to set up your virtual care appointment.
