Medicare Program Integrity Manual (Pub. 100-08), Ch. 4 § 4.9.2.3

Continue to Monitor Provider and Document Case File

Last amended: 2021Year: 2021Length: 132 wordsOfficial source
4.9.2.3 - Continue to Monitor Provider and Document Case File (Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21) Unless no additional administrative action and/or investigation is warranted, the UPIC shall not close a case simply because it is not accepted by OIG/OI. Since the subject is likely to continue to demonstrate a pattern of fraudulent activity, they shall continue to monitor the situation and to document the file, noting all instances of suspected fraudulent activity, complaints received, actions taken, etc. This will strengthen the case if it is necessary to take further administrative action or there is a wish to resubmit the case to OIG/OI at a later date. If the UPICs do resubmit the case to OIG/OI, they shall highlight the additional information collected and the increased amount of money involved.