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Medicare Fraud & Abuse Procedural Terminology & Recovery Audit Contractors Discussion


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Background Information

Increased documentation is loathe of many people in healthcare, but much of it is necessary to ensure fraud is not taking place. Proper documentation is necessary to prove what is being billed for what was performed. Clear and concise medical record documentation is critical to providing patients with quality care, ensuring accurate and timely payment for the services furnished, mitigating malpractice risks, and helping healthcare providers evaluate and plan the patient’s treatment and maintain the continuum of care.


  1. Review the rubric to make sure you understand the criteria for earning your grade.
  2. In your textbook, Health Care Finance, read:
    1. Chapter 11, “Healthcare Fraud and Abuse”
    2. Chapter 14, “Recovery Audit Contractors”
  3. Navigate to the Healthcare Finance Current Event threaded discussion.
  4. In the initial post:
    1. What are common types of Medicare fraud and abuse?
    2. How do recovery audit contractors assist facilities in ensuring they are receiving appropriate payments?
    3. Your initial post is due by the end of the fourth day of the workshop. You are responsible for replying to any questions directed to you by a classmate or the instructor.


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