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The development and referral of potential fraud cases is part of an overall effort aimed at assuring proper utilization of the Medicare program. According to Dewberry, 300 to 400 cases each month are received nationally by Social Security to investigate. These referrals which represent possible Medicare abuse are made by Medicare beneficiaries, Social Security offices, and Medicare Intermediaries and Carriers.
In most case an intent to defraud is not found. In many, however, a problem is noted which often results in a refund either to the Medicare program or affected beneficiaries. Even in those cases where no fraud or serious irregularity exists, efforts taken to investigate complaints are necessary as they serve as a safeguard to assure integrity in the Medicare program.
Dewberry stated as of the end
93.1%