decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicare Contractor Role in Fraud Enforcement / Medicare Fraud and Abuse / Types of Fraud
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Article Overview
This article reviews Medicare fraud and abuse from a compliance and enforcement perspective. It focuses on broad categories of improper billing, claim manipulation, cost-reporting problems, and related conduct that may lead to contractor scrutiny. The content is aimed at providers, billing staff, compliance teams, and auditors who need a general understanding of the types of conduct discussed in Medicare program integrity guidance.
Why This Topic Matters
Understanding the broad types of conduct discussed here helps organizations recognize areas that may draw contractor attention and support internal compliance reviews. It is relevant to anyone responsible for Medicare billing, reporting, or fraud-prevention oversight.
Article Sections
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Types of Medicare fraud and abuse
This section summarizes broad categories of conduct that may be treated as fraudulent or abusive in Medicare billing and claims activity. It covers general claim-handling, patient, and payment-related issues.
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Part A fraud
This section addresses fraud concerns connected to Part A and Medicare cost reports. It discusses general areas of cost-reporting and allocation scrutiny.
What You Will Learn
- The broad categories of Medicare fraud and abuse discussed in the article
- How contractor review can be tied to claim, payment, and cost-reporting issues
- Why cost-report submissions can create additional fraud exposure under Medicare program integrity oversight
- The kinds of compliance concerns that may be relevant to providers and billing staff
Who Should Read This
- Healthcare providers
- Medical billing and coding professionals
- Compliance officers
- Healthcare auditors
- Practice managers
- Revenue cycle teams
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