When you perform your required Medicare Fraud, Waste & Abuse training, it’s not uncommon to find issues that demonstrate your practice was noncompliant. When this occurs, you’re legally obligated to share those problems with CMS or your specific carrier.

Check out three tips that can help you report Medicare fraud if you find it during your training sessions.

Step 1: Report Internally and Stop the Problematic Activity

If you find a compliance issue during Medicare Fraud, Waste and Abuse training, you must immediately halt the problematic issue at your practice. The best way to do that is to share the problem internally, with your practice manager and providers, so they can alert everyone who’s involved with the problem and put an end to it.

For example, suppose you find an issue in which your practice has been erroneously reporting a higher level E/M code than warranted for every arthritis patient. Your first step is to share that with the practice manager, who can then triage how to alert the providers, coders and billers about the issue so it ends as quickly as possible. Your practice can develop a training program so the issue doesn’t happen again and essentially stop the bleeding before moving to step two.

Step 2: Contact Your Practice Attorney

Once everyone at your practice is aware of the issue and knows not to do it going forward, reach out to your practice’s attorney and let them know what happened. They’ll work with you to identify how many claims were affected, how much money you’ll need to reimburse to the payer, and how to go about self-reporting the issue that you found during Medicare Fraud, Waste and Abuse training.

Step 3: Return Overpayments to Medicare

Working with your practice’s attorney, you’ll identify your specific carrier’s preferred forms for reporting overpayments so you can return any money to Medicare. This is referred to as a voluntary refund. Most payers will ask you to fill out a form and then either send an electronic payment or a paper check. Your attorney will advise you on which reason codes and documents to share with your insurer.