decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Investigation Procedures / Investigation of Servicess Not Provided as Claimed / Misrepresentation of Services
Subscribe or sign in to view the full article.
Article Overview
This premium article discusses OIG investigation procedures for allegations that services were misrepresented in billing. It is aimed at compliance, audit, investigative, and coding professionals who need to understand the types of scenarios that trigger review, the information investigators try to document, and the kinds of billing and claims-processing records that may be examined.
Why This Topic Matters
Misrepresentation cases can involve a wide range of clinical settings and billing scenarios, so understanding how these investigations are framed helps organizations recognize risk areas, preserve records, and prepare for review.
What You Will Learn
- Common situations that may lead to an OIG review of alleged service misrepresentation
- The broad categories of records and statements investigators look for during an investigation
- Why claims submission details and billing documentation matter in these cases
- How provider intent and knowledge may be considered in a misrepresentation inquiry
Who Should Read This
- Compliance officers
- Medical coders
- Billing managers
- Auditors
- Healthcare investigators
- Physician practice administrators
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com