Protect your organization and employees from fraudulent billing and claims with our fraud and abuse course.
Medicare Compliance: Fraud and Abuse
Medicare Fraud & Abuse Training
It is estimated that in 2018 annual healthcare costs surpassed $3.35 Trillion, and losses from Fraud and Abuse reached to $300 billion. That’s a loss of about $820 million every day.
Whether you have employer-sponsored health insurance or you purchase your own insurance policy, healthcare fraud and abuse inevitably translates into higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits or coverage. For employers—private and government alike—healthcare fraud and abuse increases the cost of providing insurance benefits to employees and, in turn, increases the overall cost of doing business.
This Medicare fraud and abuse course provides an overview of the principle laws used to combat fraud against government healthcare programs; the False Claims Act, Anti-kickback statute, and the Stark Law and also the communication mandates from The Deficit Reduction Act. The course also details employer responsibilities in preventing fraud through establishment of compliance programs and employees’ responsibilities in identifying and preventing fraud and abuse in the workplace including whistleblower activities and protections. This fraud and abuse course was developed for all employees and level of management working in healthcare organizations who need to know the fundamental rules regarding healthcare fraud and abuse.
What is Covered
This course provides a review of the laws that are used to combat fraud and abuse against government healthcare programs including:
- False Claims Act – 31 USC ss 3729 (FCA)
- Anti- Kickback Statute – 42 USC 1320-7b(b)
- Physician Self-Referral (“Stark”) Statute – 42 USC 1320-7b(b)
- Fraud Enforcement and Recovery Act of 2009 (“FERA”)
- Patient Protection and Affordable Care Act
- Deficit Reduction Act of 2005 (DRA)
- Describe the differences between healthcare fraud and abuse.
- Describe the principle laws that are used to combat fraud and abuse against federal government healthcare programs.
- Identify the elements of healthcare fraud.
- Describe a compliance plan so employers can prevent false claims.
- Describe how employees can avoid False Claims Act violations.
- List the role of whistleblowers in False Claims Act suits and how they are protected.
- Introduction & Objectives
- Defining Fraud and Abuse
- Laws Combating Healthcare Fraud
- Compliance Plans and how Employees Can Prevent False Claims Act violations
- Role of Whistleblowers in False Claims Act suits
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