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Federal Government Auditing the Medical Necessity of the Service Provided to Medicare Beneficiaries

By Nolan and Auerbach

The federal government in part relies on private contractors, known as recovery audit contractors (RACs), to detect fraudulent activity targeting the Medicare systems. Recently, the federal government, through its agency the Center for Medicare & Medicaid Services, decided to expand one RAC?s auditing powers to include medical necessity reviews. These intensive audits are designed to determine if specific procedures in a Medicare paid claim were medically necessary for a patient’s heal read more

Full post as published by Medicare Fraud 101 on September 15, 2010 (boomark / email).