Medicare Auditors: What they're looking at, and why
Category: Auditing
The industry is buzzing with news of Recovery Audit Contractors (RAC), and even word of period Comprehensive Error Rate Testing (CERT) drifts by now and again. But there are many other oversight entities that are conducting audits as well.
Conducting internal and external audits reduces or eliminates fraud and waste, and is an important way to keep healthcare costs under control. HHS has estimated that for every $1 it spends to stop fraud, it saves $1.55, according to a May, 7, 2009 news release.
There are four main areas that HHS and government contractors are continually auditing and monitoring electronically and through desk reviews:
1. Medical necessity claims2. Fraudulent behavior3. Fraudulent activity4. Medicare services
The various types of audit activities conducted through HHS are:
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