Fraud and Abuse

YOU Can Help STOP Medicare Fraud

The Health Care Financing Administration (HCFA), who is in charge of the Medicare program, is continuing its fight to stop Fraud and Abuse. It is launching an Incentive Reward Program (IRP) starting March 1, 1999. This program offers rewards for information leading to recovery of Medicare funds.

Here are the requirements:

• There must be at least $100, in overpayments, recovered
  by Medicare;
• Complaint must be received on or after July 8, 1998;
• Information must relate to a specific situation, individual or entity, and specify the time period of the occurrence;
• It must be relevant information, not frivolous; and
• A reward is not given if the individual or entity is already the subject of a review or investigation.

The amount of reward cannot exceed 10% of the Medicare overpayment recovered or $1,000, whichever is less. If there is more than one complainant, the reward will be split equally, and will not exceed the maximum $1,000.

How do you file the complaint?

Call or write your local Medicare Program Integrity department with your complaint. The complaint will be developed and, following specific guidelines, may be forwarded to the Office of the Inspector General (OIG). If the complaint results in a sanctionable offense and all overpayments are collected, you will receive a reward eligibility notification and claim form. . The reward payment is based on the money recovered from the overpayment and is subject to the IRS tax laws.

Call your local Medicare customer service department for more information about the Incentive Reward Program.