"We are continuing to build on our fraud fighting and program integrity efforts by identifying high risk areas and trends to better focus our limited funds and resources," said Weems.

Medicare is required by law to pay claims to health care providers for services provided to beneficiaries within 30 days after the claim is submitted, as long as the claim meets Medicare's rules. After the claim is paid, CMS or its contractors can review the claim to ensure that the items or services were actually provided or the services were medically necessary. If the claim was not submitted under Medicare's rules, CMS checks to see if the claim was submitted in error or may be potentially fraudulent. Those claims that could be fraudulent are referred to law enforcement for further investigation.


For more information about CMS RAC Web site, please visit: www.cms.hhs.gov/RAC/Downloads/RAC%20Expansion%20Schedule%20Web.pdf


Medicare Fraud Strike Force Indicts Eight Miami-Dade Residents for AIDS/HIV Infusion Fraud

Eight Miami-Dade County residents have been charged in a 16-count indictment for their alleged roles in a Medicare fraud scheme involving fake HIV infusion treatments, Acting Assistant Attorney General of the Criminal Division Matthew Friedrich and U.S. Attorney for the Southern District of Florida R. Alexander Acosta announced.

Read about it:
http://www.usdoj.gov/opa/pr/2008/October/08-crm-906.html

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