Federal (United States) · Agency guidance
Chapter 4
144 sections
144 sections
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.1Introduction
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2The Medicare Program Integrity
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.1Examples of Medicare Fraud
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2Program Integrity Contractors
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.1Unified Program Integrity Contractor
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.2Investigations Medicare Drug Integrity Contractor
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.3Organizational Requirements
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.4Liability of Program Integrity Contractor Employees
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.4.1Maintain Controlled Filing System and Documentation
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.5Anti-Fraud Training
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.5.1Training for Law Enforcement Organizations
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.6Procedural Requirements
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.6.1Maintain Controlled Filing System and Documentation
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.6.2File/Document Retention
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.7Program Integrity Security Requirements
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.8Program Integrity Contractor Coordination
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.8.1Unified Program Integrity Contractor Coordination with
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.8.1.1Coordination with the Office of Inspector General
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.8.1.2Joint Operating Agreement
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.8.1.3MAC and UPIC Coordination on Voluntary Refunds
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.2.8.1.4Contractor Coordination and Suppression and Exclusion
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.2.3Durable Medical Equipment Medicare Administrative
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.3Complaints
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.3.1Definition of a Complaint
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.3.2Complaint Screening
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.3.2.1Contact Center Operations
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.3.2.2OIG Hotline
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.3.2.3MAC Complaint Screening
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.3.2.4Referrals to the UPIC
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4Home Health Agency Billing and Notice of Admission (NOA)
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4.1Education and Additional Monitoring
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4.2Corrective Action Plans
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4.2.1Notification to the HHA
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4.2.2CAP Submission
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4.2.3CAP Acceptance and Monitoring
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4.2.4CAP Closeout
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.4.3Coordination and Referral to the UPIC
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.5Screening Leads
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.5.1UPIC and I-MEDIC Responsibilities
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.6Vetting with CMS
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7Investigations
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.1Conducting Investigations
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.1.1Provider/Supplier Contacts by the UPIC
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.1.2Case Coordination with UPICs
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.1.3Collection of Records from Medicare Advantage Plans
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.2Provider Identity Theft Investigations, Victimized Provider
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.2.1Provider Identity Theft Investigations and Victimized Provider
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.2.2Identifying and Reporting Compromised Medicare Beneficiary
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.3Durable Medical Equipment Medicare Investigative Functions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.3.1Supplier Proof of Delivery Documentation Requirements
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.3.1.1Proof of Delivery and Delivery Methods
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.3.1.2Exceptions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.3.1.3Proof of Delivery Requirements for Recently Eligible Medicare
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.4Medical Review for Program Integrity Purposes
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.4.1Production of Medical Records and Documentation for an
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.4.2Reversed Denials by Administrative Law Judges on Open
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.4.3UPIC & Medical Review Accuracy Contractor Coordination
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.5Administrative Relief from Program Integrity Review in the
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.6UPIC Hospice Cap Liability Process – Coordination with the
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.7Closing Investigations
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.7.1Monitor Compliance
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.7.7.1.1Resumption of Payment to a Provider - Continued
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8Requests for Information From Outside Organizations
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.1Reversed Denials by Administrative Law Judges on Open Cases
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.2Production of Medical Records and Documentation for an
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.3Initial and Routine Communications with Providers, Suppliers
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.4Escalation of Inquiries
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.4.1Congressional Inquiries
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.4.2Escalated Inquiries Involving Investigative Outcomes and
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.4.3Escalated Inquiries Involving Payment Suspensions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.8.4.4Providers on Zone Restrictions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9Referrals
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.1Immediate Advisements to the OIG/OI
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.2Referral of Cases to the OIG/OI
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.2.1OIG/OI Referral and Summary Report
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.2.2Take Administrative Action on Cases Referred to and
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.2.3Continue to Monitor Provider and Document Case File
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.3Referral to Other Law Enforcement Agencies
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.4Referral to Other Entities
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.4.1Referral to State Agencies or Other Organizations
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.4.2UPICs and QIOs
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.4.3Referral of Cases to the MAC
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10Administrative Sanctions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.1The Unified Program Integrity Contractor’s and Medicare
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2Authority to Exclude Practitioners, Providers, and Suppliers of
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.1Basis for Exclusion Under §1128(b)(6) of the Social Security
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.2Identification of Potential Exclusion Cases
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.3Contents of Sanction Recommendation
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.4Notice of Administrative Sanction Action
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.4.1Notification to Other Agencies
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.5Denial of Payment to an Excluded Party
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.5.1Denial of Payment to Employer of Excluded Physician
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.2.5.2Denial of Payment to Beneficiaries and Others
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.3Appeals Process
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.4Reinstatements
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.10.4.1Monthly Notification of Sanction Actions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.11Civil Monetary Penalties
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.11.1Basis of Authority
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.11.2Administrative Actions
- Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.11.3Enforcement