application forms can be prosecutedorequire providers to periodically report on employees and financial backers outilize credentialing as a gatekeeper to the programofollow new providers for a certain period of time--watch their billing patterns Promote education:obeneficiaries need to be educated about program and fraud issues; find best vehicles in each community (for example, area units on aging, advocacy groups, clergy, etc.)otarget particularly vulnerable beneficiary populations, such as immigrant groups oExplanation of Medicare Benefits (EOMBs) need to be sent out in a more timely fashionoall Medicaid beneficiaries should receive EOMB type statements and be encouraged to review for inconsistencies with care provisionomore provider education, including better communication of policiesohelp beneficiaries understand that addressing fraud should not reduce access to legitimate medical services Encourage and support development of corporate compliance programs: omore consistent guidance and interpretation from HCFA and oversight groups about proper practices (for example, documentation) Promote administrative simplification:omake Medicare and Medicaid rules easier for beneficiaries and providers to understandomake it easier for beneficiaries to asked questions, report fraud Zero tolerance policy for fraud:oa zero tolerance message needs to be enforced and emphasized throughout the provider community as well as government. Change contractor incentives:ohistorically, contractors primary incentives were to pay claims quickly and efficiently. Change incentives to encourage and support fraud and abuse detection. Encourage a 'fear' of prosecution and punishment for unscrupulous providers:opublicize the punishments to achieve a sentinel effectoneed to create a fear of being detected; random on site aggressive reviews.owell focused random reviews and audits.ounannounced auditor visits Eliminate provider fear and foster ability for honest provi...
