CMS Pub. 100-08, ch. 4, § 4.11.6.2

Upon discovery of any case that may implicate any of the OIG's delegated CMP

authority, regardless of whether there is any other pending activity, or whether the fraud

case was closed, UPIC shall contact the OIG/OI Field Office to discuss the potential

case. If this contact results in a referral, the UPIC shall follow the same referral format

as described in PIM, chapter 4, §4.9.2.1. If a referral is not made or a referral is declined,

the UPIC shall consider other administrative remedies, which, at a minimum, may

include revocation of assignment privileges, establishing prepayment or post payment

medical reviews, and referral of situations to state licensing boards or

medical/professional societies, where applicable. In all situations where appropriate

Medicare payments have been identified, MACs shall initiate the appropriate steps for

recovery.

The UPIC shall send to the OIG all cases, as appropriate, where an excluded provider or

individual has billed or caused to be billed to the Medicare or Medicaid program for the

furnishing of items or services after exclusion. Such misconduct is sanctionable under

§1128A(a)(C)(1) of the Social Security Act.

The UPIC shall send to the CMS Provider Enrollment and Oversight Group all cases

where UPIC believes that misuse has occurred of the Medicare name, symbols,

emblems, or other violations as described in §1140 of the Social Security Act and in 42

CFR 1003.102(b)(7).