CMS Pub. 100-08, ch. 4, § 4.12

The Unified Case Management (UCM) System is a national database that the UPICs use

to enter and update Medicare and Medicaid fraud, waste, and abuse data analysis

projects, leads, and investigations initiated by the UPIC. Additionally, the UCM allows

the UPICs to enter and track various administrative actions (i.e., pre or post-payment

reviews, payment suspensions, revocations, etc.), requests for assistance (RFAs), and

requests for information (RFIs) that are fulfilled by UPICs at the request of law

enforcement, CMS, or other stakeholders.

Additional details related to each field in the UCM can be referenced in the UCM user

manual. The UPIC shall complete all appropriate UCM training and reference the UCM

user guide for specific instructions on how to utilize the UCM. The UPIC users shall

become proficient and knowledgeable users of the UCM. The UPIC shall be responsible

for ensuring they are using the UCM as the system of record and that all data entered into

the UCM is entered correctly. This requirement includes, but is not limited to, the

spelling of names and accuracy of addresses and identifiers that are entered, etc.

The following agencies/organizations currently have access to the UCM:

• UPICs

• National Benefit Integrity Medicare Drug Integrity Contractor (NBI MEDIC)

• Railroad Retirement Board (RRB)

• CMS contractors (FPS, PIMAS, Acumen, IBM)

• MAC Medical Review Units associated with MPIP

• CMS

• FBI

• DOJ

• HHS/OIG

• Other federal and state partners seeking to address program integrity concerns in

judicial or state health care programs

All workload received and/or initiated by the UPIC shall be saved in the UCM and shall

contain identifying information on the potential subject(s) of a project, lead,

investigation, etc., as well as general information on activities performed by the UPIC to

substantiate the allegation of potential fraud, waste, or abuse. Investigative workload

initiated by the UPIC shall contain a summary of the pertinent information related to any

activities and/or resolution, and all fields in the UCM shall be updated with the applicable

information as it is received by the UPIC.

The following are the general guidelines associated with project, investigation, RFI/RFA,

and administrative action requirements in the UCM: