decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Fraud_and_Abuse / 7_examples_of_abuse
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Article Overview
This premium article is a fraud-and-abuse reference focused on Medicare billing behavior, claim submission practices, and postpayment review. It is aimed at coders, billing staff, compliance personnel, and clinicians who need a general understanding of abuse concepts and the Medicare review environment. The discussion points to related Medicare policy areas and claim-review concepts that frame when unusual billing patterns may trigger concern.
Why This Topic Matters
Understanding Medicare abuse concepts helps organizations recognize compliance risks, connect billing behavior to Medicare rules, and identify when claims may be reviewed for abnormal patterns or medical necessity concerns.
What You Will Learn
- Common categories of Medicare abuse discussed in a compliance context
- How claim-payment patterns can differ from peer norms
- How related Medicare billing and review topics fit into abuse analysis
- Why postpayment claim review may be triggered by unusual service patterns
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Healthcare administrators
- Physicians and other billing providers
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