CMS Battles Physician ID Theft

In our digital age, identity theft is a growing concern for everyone—physicians included. Identity thieves steal providers’ personal information and use it to receive illegitimate Medicare payments, leaving the victimized providers with overpayment demands, tax liabilities, and credit degradation. Often, a provider does not know that his identity has been compromised until he receives overpayment demand letters from Medicare administrative contractors (MACs).

To help legitimate providers who have suffered unwarranted financial liability as a result of having their identities stolen by thieves who use those identities to fraudulently bill Medicare, the Centers for Medicare & Medicaid Services (CMS) has created the provider victim validation/remediation initiative.

Physicians who believe they had their identity stolen will contact program integrity contractors (comprised of program safeguard contractors (PSCs) and zone program integrity contractors (ZPICs)), who will “conduct extensive investigations and report their findings to CMS,” according to an October letter describing the program. CMS will make the final decision whether to relieve providers of liability, and will inform the affected provider of its decision, in writing.

Provider victim validation/remediation initiative contacts are listed on pages 2-5 of the CMS letter, and are grouped by state, Medicare service (Part A, Part B, durable medical equipment (DME), etc.), and contractor.

Physicians who believe they are the victims of Medicare identity theft, but who have not yet suffered any financial liability, should contact their jurisdictional MAC or contact the Office of Inspector General (OIG) hotline at 1-800-HHS-TIPS.


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