Fraud Alerts / OIG Special Fraud Alerts / Special Fraud Alert_August 1995 / False or fraudulent claims

Why This Topic Matters

The alert helps providers, facilities, compliance staff, and auditors recognize broad fraud-and-abuse risk areas in Medicare and Medicaid supply arrangements. It is especially relevant for organizations that handle nursing facility procurement, cost reporting, resident records, and supplier relationships.

Article Sections

1. False or fraudulent claims

   Overview of the types of billing and reimbursement misconduct the alert addresses, with emphasis on nursing facility supply transactions and federal program exposure.

2. Claims for medical supplies and equipment that are not medically necessary

   Discussion of supply arrangements involving items furnished to nursing facilities and billed as if they were separately reimbursable for individual beneficiaries.

3. Claims for items that are not provided as claimed or double billed

   Discussion of billing situations involving items that were not furnished as represented, as well as duplicate payment concerns across Medicare and other payers.

4. Paying or receiving kickbacks in exchange for Medicare or Medicaid referrals

   Summary of anti-kickback concerns, provider arrangement risk, and the compliance issues raised by remuneration tied to referrals or procurement activity.

5. Other examples of fraudulent practices

   Additional examples of suspected misconduct involving unordered goods, access to records, misrepresented items, and timing or documentation issues in supply billing.