Medicare Contractor Role in Fraud Enforcement / Contractor Benefit Integrity Units / Investigation of Complaints / Complaints Involving NIPs / Strong Potential for Fraud

Article Overview

This article covers Medicare contractor fraud-enforcement procedures and the role of OIG in reviewing complaints that may indicate a strong potential for fraud. It is aimed at coding, compliance, and program integrity professionals who need a high-level understanding of contractor review standards, beneficiary-contact evidence, and referral considerations. The discussion focuses on general investigative criteria and oversight responsibilities rather than billing guidance or code selection.