decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Fraud Alerts / OIG Special Fraud Alerts / Special Fraud Alert_May 1996 / Background
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Article Overview
This article provides an overview of why nursing facilities are a recurring focus of fraud concerns under Medicare and Medicaid. It is aimed at compliance staff, facility administrators, coders, and other health care professionals who need a general understanding of the payment context and the types of fraudulent arrangements discussed by the Office of Inspector General. The content is introductory and policy-oriented, with emphasis on the broader setting in which billing problems and improper service claims arise.
Why This Topic Matters
Understanding the fraud environment in nursing facilities helps organizations recognize compliance risk areas and appreciate why federal fraud alerts are issued.
What You Will Learn
- The Medicare and Medicaid reimbursement context for nursing facilities
- Why nursing facilities can be vulnerable to fraudulent arrangements
- The general role of the Office of Inspector General in identifying fraud concerns
- How improper billing and unprovided services are described at a high level in the article
Who Should Read This
- Compliance professionals
- Nursing facility administrators
- Medical coders and billing staff
- Health care auditors
- Health care providers
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