Medicare Rules: Avoid Fraud and Abuse Charges

Why This Topic Matters

Medicare claims can trigger compliance problems even when a practice does not intend wrongdoing. Understanding the article’s scope helps coding and billing teams recognize the kinds of behaviors CMS and its contractors flag as risky and why documentation, payer coordination, and claim accuracy matter.

Article Sections

1. See What Constitutes Fraud

   Defines fraud at a high level and discusses the kinds of intentional conduct Medicare oversight materials associate with fraudulent activity. It also references CMS and MAC perspectives on provider conduct and claim integrity.

2. Don’t Get Duped by ‘Abuse’ Errors

   Explains abuse as a claims and billing compliance issue and outlines broad problem areas that can affect Medicare reimbursement. The section emphasizes common operational and documentation-related risk categories for general surgery coders and other billing staff.