Beneficiary review of their explanation of benefits

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Reference no: EM133808854

Question

You are on the intake team at the Department of Justice. You receive a complaint from a Medicare beneficiary regarding the following:

(a) Based on the beneficiary's review of their Explanation of Benefits, the beneficiary believes that the government was billed for services that were not rendered.

(b) The complaint also states that their blood is taken at every monthly appointment (possible medically unnecessary procedures).

For each complaint, (a) and (b), please advise how you would proceed, and explain your decision:

1. Do you send the complaint to Civil division, or do you send the complaint to the Criminal division? Why?

2. Do you close the intake with no referral to either division? Why?

Reference no: EM133808854

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