decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicare Contractor Role in Fraud Enforcement / Contractor Benefit Integrity Units / Organizational Requirements of the BI Unit
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Article Overview
This article addresses Medicare contractor fraud-enforcement responsibilities, with a focus on the organizational role of Benefit Integrity (BI) units. It explains the kinds of cases that warrant highest priority and notes the unit’s relationship to OIG referrals. The content is relevant to compliance, auditing, and program integrity professionals who work with Medicare contractors.
Why This Topic Matters
Understanding BI unit priorities helps compliance teams and contractors recognize which allegations are treated as most urgent and how referral workflows fit within Medicare fraud enforcement activities.
What You Will Learn
- How Medicare contractor BI units organize and prioritize incoming work
- What broad categories of fraud-related cases are considered highest priority
- How BI unit referral authority relates to contractor management oversight
- The article’s focus within Medicare program integrity and fraud enforcement
Who Should Read This
- Medicare compliance professionals
- Medical auditors
- Program integrity staff
- Provider billing and coding staff
- Contractor operations personnel
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