decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicare Contractor Role in Fraud Enforcement / Contractor Benefit Integrity Units / Contractor Benefit Integrity Units
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Article Overview
This article covers the role of Medicare contractor benefit integrity units in fraud enforcement, including how these units are organized, supervised, and expected to respond to suspected wrongdoing. It is aimed at Medicare compliance, audit, and program integrity professionals who need a high-level understanding of contractor responsibilities, sources of fraud leads, and coordination with CMS and OIG.
Why This Topic Matters
Understanding contractor benefit integrity operations helps readers see how Medicare fraud concerns are identified, investigated, and referred within the program integrity framework.
What You Will Learn
- How contractor benefit integrity units fit into Medicare program integrity activities.
- The general functions and responsibilities expected of these units.
- How contractors may organize fraud-related responsibilities and coordinate with external sources of leads.
- The types of responses discussed for suspected fraud concerns.
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Healthcare auditors
- Medicare contractors
- Program integrity staff
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