decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Fraud and Abuse / 6 practices to avoid
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Article Overview
This article outlines several Medicare fraud and abuse practices that providers are cautioned to avoid. It is aimed at clinicians, billing staff, compliance teams, and practice managers who need a high-level understanding of the categories of conduct Medicare monitors and why those issues matter for payment integrity and compliance.
Why This Topic Matters
Understanding the broad categories of fraud and abuse helps practices recognize areas that may draw Medicare review and compliance attention. The article is relevant for reducing risk in billing, referrals, and patient-visit documentation processes.
What You Will Learn
- The general categories of Medicare fraud and abuse discussed in the article
- Why certain billing, referral, and visit patterns may attract payer scrutiny
- How these issues relate to Medicare compliance and payment integrity
- The kinds of practice operations that may be relevant to fraud and abuse review
Who Should Read This
- Physicians
- Billing and coding staff
- Compliance officers
- Practice managers
- Health care administrators
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