Potential Fraud Referrals
If the CERT Documentation Contractor (CDC) is unable to make contact with a provider after a series of repeated attempts, including additional commercial record searches, the Problem Resolution Office will write a Potential Fraud Referral Report and send it to the appropriate Benefit Integrity office for possible action.
A few examples of reasons that would trigger the Potential Fraud Referral Report include (but are not limited to):
- No phone number available.
- Phone listing disconnected.
- Phone is never answered.
- Phone is a mobile number.
- State records disclose no record of business activity.
- Claims submitted for decedent beneficiaries.
- Provider is out of business with no forwarding address or phone number.

