HEALTHCARE COMPLIANCE II

. What is the difference between Medicare Advantage and traditional Medicare?

2. What is a special investigation unit (SIU)?

3. Under certain circumstances, the CMS may wish to perform its own audits of a Sponsor’s or FDR’s activities pertaining to any aspect of the services provided or amounts payable under its Medicare contract. It has the right to do this, and the Sponsor must allow access to any auditor acting on behalf of the CMS or other federal government agency to conduct an on-site audit. What items will be the subject of a typical CMS audit?

4. It is not always easy for a plan sponsor to identify which of its contracted partners qualify as FDRs. The CMS recommends that the Sponsor take certain factors into account. Name four of them and explain.