The Centers for Medicare & Medicaid Services (CMS) has identified a concerning increase in fraudulent activity involving the theft and misuse of Medicare Beneficiary Identifiers (MBIs). In some cases, malicious actors have accessed and misused Medicare Administrative Contractor (MAC) MBI lookup tools to facilitate Medicare fraud.

To protect beneficiaries and maintain the integrity of the Medicare program, CMS is implementing enhanced monitoring controls to detect and prevent inappropriate use of MBI lookup tools.

What You Need to Know

The MAC MBI lookup tool should only be used to retrieve information for individuals to whom you intend to provide a service or product that will be billed to Medicare.

Under the new monitoring process, CMS will compare MBI lookup activity with actual Medicare claims submitted using National Provider Identifiers (NPIs). If an unusually high number of MBIs are accessed without corresponding claims submissions, access to the MBI lookup tool may be suspended or revoked.

Required Action: Complete MAC Portal Updates by May 7

To maintain continued access to the MBI lookup tool, organizations must ensure that all MAC portal users are properly associated with the National Provider Identifiers (NPIs) within their organization on whose behalf they may perform MBI lookups.

Associating users with the appropriate NPIs allows CMS to verify legitimate system use and helps protect your organization’s ongoing access to the lookup tool.

Michele Krpata, BSW, CPC, CPMA

Compliance Officer, Quality Reporting Analyst

Integrated Physicians Management Services