decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Medicare Contractor Role in Fraud Enforcement / Cases Referred to and Accepted by OIG / Cases Referred to and Accepted by OIG
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Article Overview
This article explains a Medicare contractor’s role in fraud enforcement and outlines the Office of Inspector General’s general options after a case referral. It is useful for compliance, auditing, and fraud-investigation audiences who need to understand the administrative workflow and the types of outcomes that may follow a referral. The discussion is framed around OIG review and related enforcement pathways rather than billing or coding mechanics.
Why This Topic Matters
Understanding how referred cases are handled helps organizations follow Medicare fraud-enforcement processes and prepare for possible administrative, investigative, or law-enforcement outcomes.
What You Will Learn
- How contractor referrals to OIG are handled at a high level
- What broad response paths OIG may take after receiving a referred case
- How the article frames contractor, administrative, investigative, and law-enforcement roles in fraud enforcement
- The general timing mentioned for OIG acknowledgment of a referral
Who Should Read This
- Compliance professionals
- Medical coders
- Billing staff
- Auditors
- Fraud and abuse investigators
- Practice managers
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