Identity Theft Scam Using Medicare Documents

BALTIMORE — According to a Thursday alert, CMS has become aware
of a scam in which perpetrators are sending faxes to physician
offices posing as the Medicare carrier or Medicare Administrative
Contractor (MAC).

The fax instructs physician staff to respond to a questionnaire
to provide an account information update within 48 hours in order
to prevent a gap in Medicare payments. The fax may have the CMS
logo and/or the contractor logo to enhance the appearance of
authenticity, the scam alert said.

A Friday update from NHIC, the A/B MAC for Part B, said once
obtained, the personal information is being used to complete
fraudulent Medicare provider applications for new practice
locations. Once the new provider number is established, the
scammers quickly submit a large volume of claims to the Medicare
carrier for payment.

In one instance, NHIC said, “a provider received a fax on what
appeared to be the carrier’s letterhead. The fax was labeled ‘CMS
File Update’ and asked for a series of documents, including copies
of the physician’s medical license and driver’s license. The
physician faxed the requested information to a toll-free ‘877’
number. The unknown party then submitted a Medicare provider
application (CMS 855) under the provider’s name and set up a ‘fake’
office in another city. The real physician discovered the fraud
when a third-party insurer contacted him for a refund on a patient
that was not his.”

According to the CMS notice, all Medicare fee-for-service
providers should be wary of this type of request. “If you receive a
request for information in the manner described above,” CMS said,
“please check with your contractor before submitting any
information. Medicare providers should only send information to a
Medicare contractor using the address found in the download section
of the CMS.gov Web site at www.cms.hhs.gov/MLNGenInfo/ or www.cms.hhs.gov/MedicareProviderSupEnroll.”