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."