decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicare Contractor Role in Fraud Enforcement / Requests for Information From Outside Organizations / Requests from the Justice Dept and FBI
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Article Overview
This article covers Medicare contractor responsibilities when responding to data and records requests tied to fraud investigations, including interactions with the Justice Department, OIG, CMS, and the FBI. It is relevant to compliance staff, auditors, investigators, and healthcare organizations that need to understand the general framework for outside information requests and referral pathways.
Why This Topic Matters
Understanding how contractor-held information may be requested and routed helps organizations recognize the oversight structure involved in fraud enforcement and compliance activities.
What You Will Learn
- How Medicare contractor information requests related to investigations are handled at a high level
- Which federal organizations are involved in the request and referral process
- What broad categories of data and records may be sought from contractors
- How contractor referrals relate to oversight and fraud enforcement pathways
Who Should Read This
- Compliance professionals
- Medical coders
- Billing staff
- Healthcare administrators
- Auditors
- Fraud and abuse investigators
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