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Deductibles & Copayments - Fraud Alert
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Medicare Deductibles & Copayments

 

     The Department of Health and Human Services Office of the Inspector General (OIG) issued a fraud alert to investigate providers and suppliers of health care items and services who are paid on the basis of reasonable charges and who routinely waive Medicare deductibles and copayments to beneficiaries for services and items covered under the Medicare program.  When a claim misrepresents the actual charge for an item or service, the provider or supplier may be subject to criminal, civil, or administrative liability for making false statements or submitting false claims. 

 

     This fraud alert is not meant to address routine waivers of copayments and deductibles by providers and suppliers who are paid on the basis of costs or diagnostic-related groups.  It also does not address the waiver of any copayment by a federally qualified health care center with respect to any individual who qualifies for subsidized services under a provision of the Public Health Services Act.