Glossary CM – COM

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CME Fraud – See Continuing Medical Education (CME) Fraud in this Glossary;

CMH Fraud – Fraud typically occurs with unnecessary admissions/falsification of patient diagnosis, and misrepresentation of services provided. See Community Mental Health Center in this Glossary.

CMHC Fraud – See Community Mental Health Center (CMHC) Fraud in this Glossary.

CMN Fraud – See Certificate of Medical Necessity Fraud in this Glossary.

CMN Kickback Fraud – See Certificate of Medical Necessity (CMN) Fraud in this Glossary.

Coding false claim – involves submitting claims for services or products with the use of billing codes resulting in a higher reimbursement than the code(s) that should have been used. See also Ambulatory Payment Classifications Fraud in this Glossary, and See Diagnosis Related Groups Fraud in this Glossary;

Community Mental Health Center (CMHC) – A CMHC may receive Medicare reimbursement for partial hospitalization services only if it demonstrates that it provides “core services” they include (a) Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of the CMHC’s mental health service area who have been discharged from inpatient treatment at a mental health facility; (b) 24 hour-a-day emergency care services; (c) Day treatment, or other partial hospitalization services, or psychosocial rehabilitation services; and (d) Screening for patients being considered for admission to state mental health facilities to determine the appropriateness of such admission.

Compendium – a comprehensive listing of drugs and biologicals, which includes a summary of the pharmacologic characteristics of each drug or biological, and includes information on dosage, as well as recommended or endorsed uses in specific diseases. Specific compendium are referred to in coverage conditions for Medicaid and Medicare Outpatient prescription drug coverage.

Compound Medicine Fraud – the mass manufacturing of drugs that are the same or similar to drugs already available on the market, and without regard to the individual needs of the patient.

Comprehensive Outpatient Rehabilitation Facility (CORF) Fraud – a CORF is an outpatient facility established and operated exclusively for the purpose of providing diagnostic, therapeutic, and restorative services for the rehabilitation of injured, disabled, or sick persons, at a single fixed location, by or under the supervision of a physician. CORFs are different from other therapy providers in that, in addition to physical therapy, regulations require that they offer psychological or social services and the services of a physician who specializes in rehabilitation medicine. They are also unique in their authority to provide a variety of nontherapy services—such as respiratory treatment or nursing care—as medically necessary in the context of a patient’s rehabilitation therapy treatment plan. In general, services are provided on the CORF premises at a single, fixed location. Back disorders, arthritis, soft tissue injuries (such as joint sprains and strains), and neurologic disorders (such as concussion) are common conditions treated at CORFs. Common fraud patterns at CORFs revolve around overutilization of services, including billing for medically unnecessary therapy services (such as for therapy services related to maintaining rather than improving a patient’s functioning),and claims for the same beneficiary made by more than one CORF (often with common ownership so as to avoid scrutiny by spreading out the claims).