decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicaid Overview / Fraud and Abuse
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Article Overview
This short article explains the basic oversight structure for fraud and abuse in state Medicaid programs. It is relevant to compliance, billing, coding, and program integrity audiences who want a high-level understanding of how state Medicaid enforcement relates to federal oversight.
Why This Topic Matters
Understanding which organizations handle Medicaid fraud and abuse is important for compliance teams and healthcare organizations working with Medicaid claims and program integrity requirements.
What You Will Learn
- How state Medicaid fraud and abuse oversight is organized at a high level
- The relationship between state and federal program integrity responsibilities
- Which organizations are associated with Medicaid program integrity oversight
- How Medicaid fraud and abuse fits into broader compliance and enforcement contexts
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Healthcare administrators
- Program integrity professionals
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