Outpatient Facility Coding Alert - 2007 Issue 12
FRAUD & ABUSE: Medicare Fraud-Hunters Expand Nationwide
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Article Overview
This article covers a Medicare fraud-and-abuse policy update focused on the planned nationwide expansion of Recovery Audit Contractors and the reaction from a physician advisory council. It is relevant to physicians, hospitals, compliance staff, and revenue integrity teams that monitor audit activity, overpayment recovery, and appeals-related policy. The discussion stays at a high level and addresses the scope of RAC activity, CMS oversight, and provider concerns about audit impact.
Why This Topic Matters
It helps readers understand a Medicare enforcement change that may affect audit exposure, overpayment recovery, and appeals workload across provider settings.
What You Will Learn
- How Medicare audit contractors are expanding their reach
- What concerns physician representatives raised about audit focus
- What policy ideas were discussed regarding appeals and provider costs
- How CMS oversight of audit contractors was described in a Medicare compliance context
Who Should Read This
- Physicians
- Hospital compliance teams
- Revenue integrity professionals
- Medical practice managers
- Healthcare attorneys
- Billing and coding professionals
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