Tag Archive for ‘Medicare and Medicaid audits’

Health insurance audit processes, penalties, and appeals

The nine common Medicare and Medicaid audits that could affect surgeons are summarized.

Medicare and Medicaid audits

This column provides an overview of seven common CMS audits that could affect physicians, and describes the penalties and appeals process for each.

Medicare and Medicaid audits

Health care fraud is a persistent and costly problem both for commercial and government payors. The Centers for Medicare & Medicaid Services (CMS) estimates that a significant amount of fee-for-service payments are misspent on improper payments every year. To address health care fraud, Congress and the CMS have developed a variety of approaches over the past several years to audit Medicare and Medicaid claims. This article is intended to present a high-level summary of these seven common audits.


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