Fraud Alerts
OIG Fraud Alert
Specialty intelligence
OIG Fraud Alert Reimbursement Alerts
Daily CMS policy updates, MAC LCD revisions, and coding guidance for OIG Fraud Alert billing teams. All alerts sourced directly from CMS, MAC contractor sites, and the Federal Register.
Total alerts
5
Average signal
71/100
Sources monitored
15+
Latest OIG Fraud Alert alerts
5Federal Register Notice: Notice of Public Data Asset Release Under the Open, Public, Electronic, and Necessary (OPEN) Government Data Act
OIG Fraud Alert
Special Fraud Alert: Suspect Payments in Marketing Arrangements Related to Medicare Advantage and Providers
OIG Fraud Alert
+ 2 more OIG Fraud Alert alerts
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MAC contractor coverage
OIG Fraud Alert billing is subject to both national CMS policy and regional MAC contractor Local Coverage Determinations (LCDs). CLV Intelligence monitors all MAC contractor sites — Noridian, CGS, First Coast, NGS, Novitas, Palmetto GBA, and WPS — for LCD updates affecting OIG Fraud Alert codes. Coverage criteria vary by contractor jurisdiction.
NoridianCGS AdministratorsFirst CoastNational Government ServicesNovitas SolutionsPalmetto GBAWPS
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Weekly digest of CMS and MAC policy changes for OIG Fraud Alert billing teams.
Frequently asked questions
What MAC contractors issue LCDs for OIG Fraud Alert billing?
OIG Fraud Alert billing is subject to regional Local Coverage Determinations (LCDs) from all seven Medicare Administrative Contractors: Noridian, CGS Administrators, First Coast Service Options, National Government Services, Novitas Solutions, Palmetto GBA, and WPS Government Health Administrators. Coverage criteria and medical necessity requirements vary by contractor jurisdiction. CLV Intelligence monitors all MAC contractor sites daily for LCD updates affecting OIG Fraud Alert codes.
How often does CMS update OIG Fraud Alert reimbursement policy?
CMS updates the Physician Fee Schedule annually, effective January 1, with proposed rules published in the summer and final rules in November. MAC contractors issue LCD updates on a rolling basis throughout the year with no fixed schedule. The Federal Register publishes proposed and final rules affecting OIG Fraud Alert reimbursement on a continuous basis. CLV Intelligence monitors all three sources daily and surfaces updates by signal strength.
What is a Local Coverage Determination (LCD) and how does it affect OIG Fraud Alert billing?
A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor specifying under what clinical circumstances a particular service is covered within its geographic jurisdiction. For OIG Fraud Alert billing teams, LCDs define medical necessity criteria, covered diagnoses, and documentation requirements for specific procedures. Failure to comply with LCD requirements is among the most common causes of Medicare claim denial in OIG Fraud Alert practices.
Reimbursement guides & resources
Plain-language guides to the policy cycles that drive OIG Fraud Alert reimbursement — the fee schedule, ICD-10, HCPCS, and Local Coverage Determinations.
2027 Fee Schedule Guide
How the CY2027 Medicare Physician Fee Schedule works and what to track.
ICD-10 Change Center
The FY2027 ICD-10-CM update cycle and the October 1 effective date.
HCPCS Quarterly Update
How HCPCS Level II changes every quarter — Jan, Apr, Jul, Oct.
Tracking LCD Changes
How LCDs change across all seven MACs and how to track them.
2027 Prep Checklist
A free, printable checklist for the CY2027 fee schedule cycle.
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