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In the News: Ineligible Providers in Medicare Part C and Part D

CMS contracts with Medicare Advantage plans and private prescription drug plans to offer Part C and Part D managed care benefits to eligible beneficiaries. Federal law prohibits Medicare payments for services provided or prescriptions written by individuals or entities who are excluded from Federal health care programs when the plans know or have reason to know of the exclusion. Federal regulations also prohibit Medicare payments to ineligible providers whose billing privileges have been deactivated, denied, or revoked. We will conduct a nationwide audit of Medicare Part C and Part D managed care data for calendar years 2018 and 2019. 

This will mandate constant reviews by Medicare beneficiaries, payors and others who employ providers to ensure there are zero violations of these rules.  White Collar, llc is the obvious solution to investigate those who are responsible for following these policies to prevent further fraud and/or abuse.