National Benefit Integrity
Medicare Drug Integrity Contractor (NBI MEDIC) Overview
The NBI MEDIC is the Medicare Part C and Part D program integrity contractor for the Centers for Medicare & Medicaid Services (CMS). Medicare Part C is known as Medicare Advantage and Medicare Part D is known as Prescription Drug Coverage. The purpose of the NBI MEDIC is to detect and prevent fraud, waste and abuse (FWA) in the Part C and Part D programs on a national level.
Follow this link for more specific details and a referral form for referring fraud cases...
The NBI MEDIC monitors and performs analysis of various types of data for the purpose of detecting FWA activity and developing candidates among plans, providers and beneficiaries for further investigation. In addition, the NBI MEDIC works with law enforcement, Medicare Advantage Organizations, prescription drug plans, consumer groups and other key partners to protect consumers and enforce Medicare’s rules. We also provide basic tips for consumers so that they can protect themselves from potential scams.
The type of complaints the NBI MEDIC is interested in receiving include:
- An individual or organization pretends to represent Medicare and/or Social Security, and asks you for your Medicare or Social Security number, bank account number, credit card number, money, etc.
- You had your personal information stolen or suspect someone has stolen your personal information.
- Someone asks you to sell your Medicare prescription drug card or Medicare Advantage plan membership card.
- Someone offers to pay you cash to visit specific providers, suppliers, or pharmacies.
- Someone asks you to get drugs for them using your Medicare prescription drug card or Medicare Advantage plan membership card.
- Your pharmacy did not give you all of your drugs.
- You were billed for drugs or services that you did not receive.
- You received a different drug than your doctor ordered.
- Your explanation of medical benefit forms list products or services you did not receive or do not accurately reflect the nature of the products or services you received.
Please contact us at 1-877-7SafeRx – (1-877-772-3379) to report complaints about any of these types of fraud, waste, and abuse issues or a related complaint.
Your Health Insurance Plan or 1-800-Medicare (1-800-633-4227) can assist you in resolving or reporting complaints involving:
- The quality of care provided by plans, nursing homes, hospitals, home health agencies, and dialysis facilities.
- Choosing or changing your Medicare coverage.
- Services covered under Medicare Part A or Part B.
- Finding doctors or other health care providers and suppliers who participate in Medicare.
- Issues regarding the price of your medications
- Issues involving the deduction of your Premium
- issues involving the drugs included in your formulary offered by your Medicare prescription drug or Medicare Advantage plan
