• If the activity is determined to be problematic, all overpayments can be recovered and the provider will be offered additional education.
• The provider can be referred to Medical Review for Pre-payment and Post-payment reviews.
• The case can be referred to the Office of Inspector General.
• The provider faces potential sanctions or exclusion from the Medicare program.

When a case is referred to the Office if Inspector General, there can be criminal and/or civil prosecution, sanctions / monetary penalties, and/or exclusion from the Medicare program.