Medicare Contractor Role in Fraud Enforcement / Administrative Remedies and Sanctions / Educational Contact and-or Warning

Article Overview

This article covers the Medicare contractor process for responding to questionable or improper provider practices and the administrative follow-up that may occur if concerns continue. It is useful for providers, compliance staff, and coding/billing professionals who need a general understanding of contractor communications, case closure, and potential escalation involving Medicare program integrity functions. The guidance is presented at a high level and focuses on the types of responses and actions discussed in the Medicare program integrity context.