Medicare audits are a permanent and expanding component of federal oversight, driven by ongoing efforts to combat fraud, waste, and abuse across the healthcare system. As scrutiny from Medicare contractors continues to intensify, providers must understand not only why audits occur, but also how different audit entities operate and what triggers their reviews.

This session demystifies the Medicare audit landscape by clearly explaining the roles, authority, and methodologies of key audit contractors, including RACs, UPICs, SMRCs, and CERT. Participants will gain insight into how these entities differ in scope and approach, as well as current audit trends and emerging areas of focus impacting providers today.

Building on this foundation, the session provides practical strategies for responding to audits and navigating the appeals process. Attendees will leave with actionable tools to strengthen documentation, mitigate risk exposure, and position their organizations for more favorable audit outcomes in an increasingly complex regulatory environment.