Question

Which of the following workers reviews records for the Centers for Medicare and Medicaid Services, looking for fraud and evidence of overcharging by facilities?

a) Medicare auditor
b) Healthcare inspector
c) Medicaid investigator
d) Compliance analyst

Answer 1

The worker who reviews records for the Centers for Medicare and Medicaid Services (CMS) specifically to identify fraud and evidence of overcharging by facilities is typically referred to as a “Medicare auditor” (option a). These auditors specialize in examining healthcare records and billing practices to ensure compliance with Medicare regulations and to detect any fraudulent or overcharging activities within healthcare facilities.

Answer 2

A Medicare auditor reviews records for the Centers for Medicare and Medicaid Services, looking for fraud and evidence of overcharging by facilities.

Step-by-step explanation:

The worker who reviews records for the Centers for Medicare and Medicaid Services, looking for fraud and evidence of overcharging by facilities is called a Medicare auditor.

Medicare auditors are responsible for examining medical billing and coding practices to ensure they comply with Medicare regulations. They investigate suspicious claims and work to prevent fraud and abuse in the Medicare system.

Some examples of fraudulent activities that Medicare auditors detect include billing for services not provided, upcoding (billing for a more expensive service than what was provided), and billing for unnecessary tests or procedures.