OIG Special Fraud Alert
 
  • Texas House Bill 610
  • Texas Department of Insurance 28 TAC 21.2801 - 21.2809
  • Texas Insurance Code Article 3.70-3C 3(m)
  • Texas Insurance Code Article 20A.09 (j)
  • Texas Insurance Code Article 21.55
test1

59 Fed. Reg. 65,372, 65,374 et seq. (Dec. 19, 1995)

"A provider, practitioner, or supplier who routinely waives Medicare co-payments or deductibles is misstating its actual charge. For example, if a supplier claims that its charge for a piece of equipment is $100, but routinely waives the co-payment, the actual charge is $80. Medicare should be paying 80 percent of $80 (or $64), rather than 80 percent of $100 (or $80). As a result of the supplier's misrepresentation, the Medicare program is paying $16 more than it should for this item."

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