Highmark Medicare Services - A CMS Contractor - ISO 9001:2000 Certified
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Providers and suppliers have an obligation, under law, to conform to the requirements of the Medicare program. Fraud committed against the program may be prosecuted under various provisions of the United States Code and could result in the imposition of restitution, fines, and, in some instances, imprisonment. In addition, there is also a range of administrative sanctions (such as exclusion from participation in the program) and civil monetary penalties that may be imposed when facts and circumstances warrant such action. Providers are responsible for knowing and following national Medicare coverage and billing guidelines contained in the statute, regulations, coverage issues, and provider manuals. Providers are also responsible for following local MR policies (LMRPs) developed and distributed by the servicing contractor. Providers must remain aware of new and changed policies, and continue to ensure that correct bills are submitted.

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