US · guidance
CMS Pub. 100-16, ch. mc86c17d, § 50.3.2
Fraud in Enrollment or Abuse of Membership Cards
A Medicare beneficiary may be disenrolled if he/she commits fraud in connection with
his or her enrollment or permits abuse of the membership card, e.g., the beneficiary
knowingly provides fraudulent information on the application form, which materially
affects eligibility for enrollment, or a Medicare beneficiary permits others to use his/her
membership card to receive services. This category includes any abuse relating to cost
plan membership or the Medicare program.
In the case of fraud or abuse, the plan must send the beneficiary written notice of
termination prior to submission of the disenrollment notice to CMS. The plan must
include an explanation of the member’s rights to a hearing under grievance procedures
established by the organization, and also notify the RO so that the Office of the Inspector
General may initiate its own investigation of the alleged fraud or abuse.
History
(Rev. 38, 10-31-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
575ad17406a053e8738631fe3f73d8e8be12f40ee9d818090fa7a8233843a324
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