RISC Tools
Interactive tool that provides links and summary information from DOL data, USPS EMF and CRIMES investigative activity for all claimants on the Daily Roll or Periodic Roll.
Claimant Risk Analysis Model
This is a claimant benefit which covers the first 45 days following a traumatic injury.
Continuation of Pay
These are the numbers of the OIG Provider Fraud and Claimant Fraud Inspector General Manual (IGM) section.
353 & 354
This scheme involves submitting multiple claims for the same service.
Double Billing
The DOL chargeback year runs from this day to this day yearly.
July 1 - June 30
This is the name of the tool used to identify all things medical coding for national drug code related.
Drugs and Medical Services Report (DMSR)
Earnings from this type of employment in which the employee was working at the time of injury must be excluded when determining both average annual earnings as well as wage-earning capacity.
Concurrent Dissimilar Employment
The ramifications of not providing a HIPAA letter to a physician/provider prior to interviewing them in a claimant investigation.
The agent is prohibited from utilizing information from that interview in USPS disciplinary proceedings.
"Phantom Billing" is also known as?
Billing for Services Not Rendered
In CBY 21 the total cost to the USPS was this amount.
$1.32B
Tool that provides detailed medical/compensation/ CRIMES information for any claimant who has ever filed a claim w/ OWCP.
Claimant Detail Report
This form is to be used to seek reimbursement for out of pocket medical expenses related to the treatment of an accepted condition.
OWCP Form 915
This is the maximum number of years allowed when calculating a cost avoidance based on a PF exclusion.
10 (IGM 353.15.G.3.b)
This scheme involves billing for a related service with a higher reimbursement rate than the service actually provided.
Upcoding
For calculating administrative fees the USPS is considered this type of agency.
Fair Share
Two tripwires that are available in the HC tripwire menu.
Death Master Billing, TACS workhours/compensation dual payments, Employees/Claimants living at same address, Claimants with Paid Gym Memberships, Transportation, Cryptocurrency, Provider Sun/Hol Billing
FECA provides that compensation for wage loss be paid to the claimant at these two rates.
66 2/3 percent of the employee’s regular pay without dependents. 75 percent with dependents.
The two types of cases that do not require OGC approval when submitting an administrative report to the Postal Service are:
When the only alleged misconduct is unreported outside income or when the claim is considered fraudulent at inception.
This scheme refers to a method of bribery where something of value is exchanged for a positive outcome or favorable decision.
Kickback
In CBY 21 the administrative costs paid by the USPS was approximately this amount.
$88M
This is a multi-disciplinary tool which matches and compiles data related to pandemic relief.
PRAC Dashboard
Web based application that provides agencies the ability to review & download OWCP claim file documents.
Employees' Compensation Operations & Management Portal (ECOMP)
These individuals, most often seen in kickback schemes, are not considered "providers" per policy.
Marketers, Sale Reps, Schedulers, Surgical Coordinators (IGM 353.14.C)
Scheme in which the claimant lies about their physical capabilities in order to continue to receive benefits.
Activity
The DOL chargeback bill is forwarded to this USPS executive (title - bonus point for name).
Chief Financial Officer (Joseph Corbett)