tci Part B Insider - 2019 Issue Q3

Compliance: Understand How Fraud and Abuse Are Different

Hint: ‘Gang visits’ aren’t what you think. You may think that CMS is easing up on compliance with its policy rollback renaissance over the last year. But federal enforcement activity indicates that Medicare fraudsters and abusers remain hot targets — and that’s why you need to know the essentials to stay compliant. What Constitutes Medicare Fraud? Though we often throw fraud and abuse into the same category, they are different. “Fraud occurs when someone intentionally falsifies information in an effort to deceive Medicare,” explains Gail O’Leary, consultant with Part B Medicare Administrative Contractor...

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