Medicare Contractor Role in Fraud Enforcement / Administrative Remedies and Sanctions / Suspending Payments / Provider Notification Requirements

Article Overview

This article covers Medicare contractor responsibilities when suspending payments, including the notification process, provider response rights, and the limited circumstance in which advance notice may be bypassed when fraud evidence is present. It is relevant to compliance staff, providers, auditors, and coding/reimbursement professionals who need to understand administrative remedies and sanctions under Medicare policy. The discussion is focused on procedural requirements, timing, and contractor obligations rather than clinical coding guidance.