J5 MAC Part A Providers serving beneficiaries in Iowa, Kansas, Missouri and Nebraska

Fraud & Abuse

WPS is committed to reducing the drain that fraud puts on America's health care system, but we need your help. You can help us reduce the impact of Medicare fraud by reporting fraud or instances of improper practices.

What is Fraud?

Fraud is the intentional deception or misrepresentation that an individual makes, knowing it to be false and that their actions could result in some unauthorized benefit to the individual.

The most frequent kind of fraud arises from a false statement or misrepresentation that is material to entitlement or payment under the Medicare program.

What is Abuse?

Abuse is the term that describes incidents or practices of providers that are inconsistent with accepted sound medical, business, or fiscal practices. These practices may, directly or indirectly, result in unnecessary costs to the Medicare program, improper payment, or payment for services that fail to meet professionally recognized standards of care, or that are medically unnecessary.

Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly or intentionally misrepresented facts to obtain payment.

Integriguard works closely with other Medicare contractors and federal agencies including the Office of Inspector General, Department of Justice, Federal Bureau of Investigation, Assistant U.S. Attorneys, state certifying agencies, etc.

Important tools for detecting, deterring, and preventing fraud are the referrals we receive from external sources.

Reporting suspected instances of Fraud & Abuse

Provider Contact Information:
IntegriGuard, LLC
2121 North 117th Avenue, Suite 200
Omaha, NE 68164
(402) 955-2781

Benefits Integrity fax: (402) 955-0783
General fax: (402) 955-2782
Cahaba Safeguard Administrators, LLC (CSA)
500 East Court Avenue, Suite 500A1
Des Moines, IA 50309-2019
General Fax (205) 220-7998
Beneficiary Complaint Contact Information:
Contact 1-800-MEDICARE (1-800-633-4227)

 

 

Page Last Updated: Friday, 06-Nov-2009 14:04:40 CST