Which program identifies improper Medicare payments and fights fraud, waste, and abuse?

Which program identifies improper Medicare payments and fights fraud, waste, and abuse?

• A. QIOSC
• B. PHSA
• C. Recovery Audit Programs
• D. Qui tam

Answer: (C)

Recovery Audit Programs are designed to target improper Medicare payments and combat fraud, waste, and abuse by performing post-payment reviews to detect overpayments and recover funds. Under CMS, Recovery Audit Contractors review paid claims, identify coding errors, duplicate payments, misapplied rules, and other improper payments, and then recoup the overpaid amounts to strengthen program integrity. The audits generate data that helps reduce future improper payments and improve payment accuracy across the program. Other options focus on different functions: one centers on quality improvement in care, another on the statutory framework behind federal health programs, and a different mechanism is a whistleblower-driven enforcement path under the False Claims Act, not a standing program for ongoing Medicare payment recovery.

Recovery Audit Programs are designed to target improper Medicare payments and combat fraud, waste, and abuse by performing post-payment reviews to detect overpayments and recover funds. Under CMS, Recovery Audit Contractors review paid claims, identify coding errors, duplicate payments, misapplied rules, and other improper payments, and then recoup the overpaid amounts to strengthen program integrity. The audits generate data that helps reduce future improper payments and improve payment accuracy across the program. Other options focus on different functions: one centers on quality improvement in care, another on the statutory framework behind federal health programs, and a different mechanism is a whistleblower-driven enforcement path under the False Claims Act, not a standing program for ongoing Medicare payment recovery.