decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicare Contractor Role in Fraud Enforcement / Contractor Benefit Integrity Units / Fraud Detection Leads / Fraud Detection Leads
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Article Overview
This article discusses the role of Medicare contractors in fraud enforcement, focusing on how contractor benefit integrity units gather and evaluate fraud detection leads. It is aimed at compliance professionals, medical coders, billing staff, auditors, and anyone working with Medicare program integrity. The content covers broad categories of lead generation, referral sources, and external information channels used to flag possible fraud, waste, or abuse.
Why This Topic Matters
Understanding where fraud detection leads come from helps organizations recognize the types of information Medicare contractors monitor when identifying potential program integrity concerns.
What You Will Learn
- Where Medicare contractors may receive potential fraud and abuse leads
- What general categories of sources contribute to fraud detection efforts
- How contractor, CMS, and external information channels fit into program integrity monitoring
- Why data analysis and complaint-based leads are part of fraud detection workflows
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Auditors
- Program integrity professionals
- Healthcare administrators
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