decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicare Contractor Role in Fraud Enforcement / Requests for Information From Outside Organizations / Requests the Contractor Says are Excessive
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Article Overview
This short Medicare compliance article explains the contractor’s role when outside organizations request information connected to fraud enforcement. It focuses on the broad circumstances that can make a request burdensome, expensive, untimely, or otherwise outside the contractor’s agreement, making it relevant to compliance staff, auditors, and Medicare administrative contractors reviewing information requests.
Why This Topic Matters
Organizations that work with Medicare contractors need to understand when an information request may be considered unreasonable so they can assess workload, scope, and timing concerns within the applicable guidance framework.
What You Will Learn
- How Medicare contractor information requests from outside organizations are framed in the fraud-enforcement context.
- What general characteristics may lead a contractor to view a request as excessive or unreasonable.
- How the article positions scope, cost, and timing concerns in relation to contractor responses.
- The basic compliance context referenced by the article guidance.
Who Should Read This
- Medicare administrative contractors
- Compliance officers
- Medical auditors
- Provider operations staff
- Fraud and abuse investigators
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