Physicians Beware of Medicare Scam
[Posted 01/06/05]

CMA has learned that a group of individuals claiming to be Medicare fraud investigators or employees of Medicare’s enrollment, claims, or audit units have been contacting physician offices and attempting to obtain information about physicians and their businesses. The callers claim that the Medicare computer system crashed and they need to update the lost information. Once they obtain this information—including the physician’s drivers license, Medicare identification, and medical license numbers—the unscrupulous individuals submit falsified forms to Medicare, seeking to change the physician’s practice location of record, telephone number, and pay-to address.

Physicians may receive legitimate requests for information from NHIC, California’s Medicare carrier. If there are any questions or concerns about the person requesting that information, you should:

• Ask for the inquirer’s telephone number (but not his or her direct line), and call back to confirm their identity. If they give you a badge number, be aware that Medicare/NHIC employees do not have badges.
• Obtain the control number for the information being requested, and call NHIC to verify the request. (In Northern California, call 877/591-1587; Southern California, 866/502-9054.)
• If the request is in writing, make sure it is on a letterhead. Compare the letterhead to previous communications that you have received from NHIC.

Report any suspicious inquiries by calling the U.S. Office of the Attorney General’s fraud hot line, 800/HHS-TIPS.

Contact: CMA’s reimbursement help line, 888/401-5911.