decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Medicare Contractor Role in Fraud Enforcement / Administrative Remedies and Sanctions / Administrative Remedies and Sanctions
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Article Overview
This article reviews the role of Medicare contractors in addressing billing-related noncompliance through administrative remedies and sanctions. It is aimed at readers who need a high-level understanding of Medicare program integrity processes, provider compliance response options, and the broader categories of actions contractors may take when improper billing concerns arise.
Why This Topic Matters
Understanding these contractor tools helps providers, compliance staff, and auditors recognize how Medicare issues are managed before more serious sanctions are considered.
What You Will Learn
- The general purpose of administrative remedies in Medicare oversight
- How contractors use less severe corrective actions to address billing concerns
- The relationship between administrative remedies and more punitive sanctions
- The types of Medicare program integrity actions discussed at a high level
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Healthcare administrators
- Auditors
- Medicare providers
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