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Medicare

A federal health insurance program for people 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

Medicaid

A joint federal and state program that helps cover healthcare costs for people with limited income and resources.

Centers for Medicare & Medicaid Services (CMS)

The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Programs, and the Health Insurance Marketplace.

Provider of services or supplier

A doctor, hospital, clinic, or other healthcare professional or facility that provides medical care and bills Medicare for those services.

Credible allegation of fraud

A specific and believable accusation of deceptive practices against a healthcare provider to illegally obtain payments from Medicare.

Payment suspension

When the government temporarily stops paying a healthcare provider for services under Medicare, usually due to suspected fraud, waste, or abuse.

Unified Program Integrity Contractors (UPICs)

Companies hired by the Centers for Medicare & Medicaid Services (CMS) to detect and investigate potential fraud, waste, and abuse in the Medicare and Medicaid programs.