decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Medicare Contractor Role in Fraud Enforcement / Contractor Benefit Integrity Units / Maintaining Files
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Article Overview
This article covers Medicare contractor duties related to maintaining fraud and abuse case histories, organizing provider files, documenting contacts and investigative materials, and performing periodic internal reviews. It is relevant to compliance staff, benefit integrity units, auditors, and other professionals involved in Medicare program integrity operations. The guidance focuses on administrative recordkeeping and monitoring practices rather than clinical coding.
Why This Topic Matters
Accurate case files and consistent internal review processes are central to Medicare fraud enforcement, documentation integrity, and ongoing program oversight. Readers will use this article to understand the operational expectations for contractor-managed fraud and abuse records.
What You Will Learn
- How contractors are expected to maintain fraud and abuse case histories and supporting documentation.
- What types of provider-related records should be kept in contractor files.
- How case numbering, correspondence control, and contact documentation are handled at a high level.
- Why periodic review and internal monitoring are part of fraud and abuse oversight.
Who Should Read This
- Medicare contractors
- Benefit integrity staff
- Compliance professionals
- Program integrity auditors
- Healthcare administrators
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