Medicare Compliance: Fraud and Abuse

It is estimated that annual healthcare costs surpassed $3.35 trillion in 2018, and losses from fraud and abuse reached $300 billion—a loss of about $820 million every day. Whether covered by employer-sponsored health insurance or individual policies, 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. The financial and legal consequences for organizations can be severe, including hefty fines, exclusion from federal healthcare programs, and criminal prosecution.

This Medicare Fraud and Abuse course provides a comprehensive overview of the principal laws used to combat fraud against government healthcare programs including the False Claims Act, Anti-Kickback Statute, and Stark Law, along with communication mandates from the Deficit Reduction Act. The training 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. Developed for all employees and management working in healthcare organizations, this course ensures your team understands the fundamental rules regarding healthcare fraud and abuse.