What action may trigger a Medicare audit?

Billing anomalies or unusual patterns in claims submissions are significant indicators that may trigger a Medicare audit. Medicare relies heavily on data analysis to monitor billing practices and ensure that services billed to the program align with the care provided. If a provider consistently submits claims that deviate from typical patterns—whether through unusually high billing amounts, billing for services not rendered, or discrepancies in coding—this raises flags for Medicare review. Such anomalies might suggest potential fraud, abuse, or billing errors that warrant further investigation to protect the integrity of the Medicare program and its beneficiaries.

The other options, while important in their own context, do not typically correlate with triggering an audit. High patient satisfaction ratings reflect service quality but do not impact billing scrutiny. Frequent compliance training indicates a proactive approach to adhering to regulations but does not directly relate to billing practices. A reduction in claim submissions might stem from various patient or provider circumstances and is not inherently an audit trigger in the same way that billing anomalies are.