Durable Medical Equipment Medicare Administrative

4.2.3 - Durable Medical Equipment Medicare Administrative Contractor Fraud Functions (Rev. 11962; Issued: 04-21-23; Effective: 05-22-23; Implementation: 05-22-23) The UPICs shall process all complaints alleging DMEPOS fraud and abuse that are filed in their regions/zones in accordance with requirements of PIM Chapter 4, §4.6. The PI unit manager has responsibility for all PI unit activity, including the coordination with outside organizations as specified in the PIM, chapter 4, §4.2.2.8. A. General Requirements Since the Medicare program has become particularly vulnerable to fraudulent activity in the DMEPOS area, each UPIC shall: • Routinely communicate with and exchange information with its MR unit and ensure that referrals for prepayment MR review or other actions are made. • Consult with the UPIC medical directors in cases involving medical policy or coding issues. • Fully utilize data available from the MAC with the pricing, data analysis and coding function (PDAC) to identify items susceptible to fraud. • Keep the PDAC contractor, other UPICs, BFL, with a copy to the COR, and SMEs informed of its ongoing activities and share information concerning aberrancies identified using data analysis, ongoing and emerging fraud schemes identified, and any other information that may be used to prevent similar activity from spreading to other jurisdictions.