Durable Medical Equipment Medicare Investigative Functions

4.7.3 - Durable Medical Equipment Medicare Investigative Functions (Rev. 11962; Issued: 04-21-23; Effective: 05-22-23; Implementation: 05-22-23) 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.