Question

This entity provides benefit integrity investigations based on billing abnormalities identified by data analysis or allegations of fraud and abuse. This group conducts reviews that will allow them to compare billing of Medicare claims to Medicaid claims known as the "Medi-Medi" program that helps to identify fraudulent activity between the two programs. Which entity is this?

A) Medicare
B) Medicaid
C) Benefit Integrity Unit
D) Fraud and Abuse Investigations

Answer 1

The entity that conducts benefit integrity investigations of Medicare and Medicaid, via programs like Medi-Medi, is the Benefit Integrity Unit. This unit works to prevent fraud and abuse in these public health programs.

Step-by-step explanation:

The entity in question that provides benefit integrity investigations and conducts reviews, such as the Medi-Medi program (compares billing of Medicare claims to Medicaid claims), to identify fraudulent activities between these two programs is the Benefit Integrity Unit. This unit is dedicated to ensuring that both Medicare and Medicaid are not subject to billing fraud by healthcare providers.

The goal of the Benefit Integrity Unit is to protect public funds and maintain the integrity of health programs by preventing moral hazard and adverse selection, which can occur when providers take advantage of the system by overbilling or submitting false claims.