Which practice helps prevent fraud and abuse in a medical office?

• A. Internal monitoring and auditing
• B. Employee training
• C. Policy development
• D. Patient access to PHI

Answer: (A)

The main concept is proactive detection through internal monitoring and auditing to prevent fraud and abuse. Regularly reviewing billing claims, coding patterns, and documentation against established policies and payer rules helps spot improper coding (like upcoding or unbundling), duplicate bills, or services that aren’t supported by records. This ongoing oversight enables timely corrective actions, reinforces accountability, and supports a formal compliance program that regulators expect. While training staff and clear policies are important, they don’t by themselves catch improper activity without ongoing audits. Allowing patients direct access to PHI isn’t a preventative measure for fraud and can raise privacy concerns.