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Building partnerships
that champion integrity is the philosophy adopted by TrustSolutions. As
a Program Safeguard Contractor (PSC) for the Centers
for Medicare and Medicaid Services (CMS), we work in partnership with
the Office of Inspector General (OIG), the United States Attorney's Office,
the Federal Bureau of Investigation,
the U.S. Postal Inspection
Service, the Internal Revenue Service,
state agencies, other Medicare contractors, healthcare providers, and
Medicare beneficiaries to foster protection of the Medicare Trust Fund.
We strengthen our relationships by continually providing data and statistical
expertise as well as case review expertise to many of these agencies.
We also conduct presentations throughout the country to showcase successful
cases and to provide training on Medicare benefits.
As our partners rely
heavily on us, TrustSolution relies upon them to further our fraud
cases
into the justice system. Their expertise in the healthcare legal system
is
invaluable to TrustSolutions and to the fight to stop Medicare fraud.
TrustSolutions works cooperatively
with the Department of Healthcare and Family Services (HFS) on the Medi/Medi
project in Illinois. The purpose of the Medi/Medi project is to combat fraud and abuse
through the incorporation of data analysis techniques applied to a ‘matched’
database of Medicare and Medicaid claims.
The healthcare provider
community also works closely with TrustSolutions to help in the
fight against
Medicare fraud and abuse. Quite often providers come forth to self disclose
a billing or financial error - a win-win situation for both the provider
and the Medicare Program. Medicare contractors, CMS, and law enforcement
recognize the integrity exemplified by these high standard providers.
Please refer to The Fraud Prevention Checklist for Medicare Providers
for other actions providers can take to protect themselves from becoming
a victim of Medicare fraud and abuse and to assist in protecting the Medicare
Trust Fund. |
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USAO
United States Attorney's Office
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The United States
Attorneys serve as the nation's principal litigators under the direction
of the Attorney General. There are 93 United States Attorneys stationed
throughout the
United States, Puerto Rico, the Virgin Islands, Guam,
and the Northern Mariana Islands. Each United States Attorney is the
chief federal law enforcement officer of the
United States within his
or her particular jurisdiction.
United States Attorneys
conduct most of the trial work in which the United States is a party.
This includes prosecuting Medicare health care fraud cases. The United
States Attorneys have three statutory responsibilities under Title 28,
Section 507 of the United States Code:
· the prosecution of criminal cases brought by the Federal government;
· the prosecution and defense of civil cases in which the United
States is a party; and
· collection of debts owed the Federal government which are
administratively uncollectible. |
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CMS
Centers for Medicare and Medicaid Services |
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The Centers for Medicare
& Medicaid Services (CMS) is a federal agency within the U.S. Department
of Health and Human Services. CMS runs the Medicare and Medicaid
programs
- two national health care programs that benefit about 75 million Americans. |
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DOJ
Department of Justice
AUSA
Assistant United States Attorney |
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The Department of Justice
was established in June 1870 (28 U.S.C. 501, 503), with the Attorney General
as its head. The Department represents the citizens of the United States
in enforcing the law in the public interest and plays a key role in protection
against criminals; ensuring healthy competition of business; safeguarding
the consumer; enforcing drug, immigration, and naturalization laws; and
protecting citizens through effective law enforcement. This department
represents the government in prosecuting Medicare fraud cases. |
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FBI
Federal Bureau of Investigations |
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The FBI is the principal
investigative arm of the United States Department of Justice.
It has the
authority and responsibility to investigate specific crimes assigned to
it,
including health care fraud. |
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MFCU
Medicaid Fraud Control Units |
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Medicaid is a jointly-funded,
Federal-State health insurance program for certain low-income and needy
people. It covers approximately 36 million individuals including children,
the
aged, blind, and/or disabled, and people who are eligible to receive
federally assisted income maintenance payments. Although the States are
primarily responsible for policing fraud in the Medicaid program through
Medicaid Fraud Control Units, CMS provides technical assistance, guidance,
and oversight in these efforts. |
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OIG
Office of Inspector General |
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The OIG is a division
under the Department of Health and Human Services. The OIG works to protect
the integrity of Department of Health and Human Services (HHS) programs,
as well as the health and welfare of the beneficiaries of those programs.
The OIG has a responsibility to report both to the Secretary and to the
Congress program and
management problems and recommendations to correct
them. The OIG's duties are
carried out through a nationwide network of
audits, investigations, inspections, and
other mission-related functions
performed by OIG components. |
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OI
Office of Investigations |
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The OI is a branch of
the OIG. This agency is responsible for the investigation of fraud and
abuse within the Department of Health and Human Services Programs, including
Medicare. In addition, the OI provides a variety of information related
to the prevention of fraud and abuse, such as compliance program guidelines,
Fraud Alerts, Advisory Opinions,
Corporate Integrity Agreements, and a
listing of health care providers/individuals that are sanctioned from
participating in the Medicare Program. |
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QIO
Quality Improvement Organizations |
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Medicare Contractors
which monitor the quality of care provided to Medicare beneficiaries
to
ensure that health care services are medically necessary, appropriate,
provided in a proper setting, and are of acceptable quality. |
