What are the laws governing Medicare Parts C and D?
Does Medicare Parts C and D require a compliance program?
Medicare Parts C and D plan Sponsors are not required to have a compliance program.
Are the standards of conduct the same for every Medicare Parts C and D sponsor?
Standards of Conduct are the same for every Medicare Parts C and D Sponsor.
Which of the following are examples of actions that may constitute Medicare abuse?
Examples of actions that may constitute Medicare abuse include: Billing for unnecessary medical services; Billing for brand name drugs when generics are dispensed; • Charging excessively for services or supplies; and • Misusing codes on a claim, such as upcoding or unbundling codes.
What requires intent to obtain payment and the knowledge that actions are wrong?
Fraud requires the person to have an intent to obtain payment and the knowledge that their actions are wrong. Waste and abuse may involve obtaining an improper payment, but does not require the same intent and knowledge.