Course Overview

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.

Build a Safer, More Compliant Workplace

What You’ll Learn

Upon completing this course, your employees will be able to:

✓ Describe differences between healthcare fraud and abuse

✓ Identify principal laws combating fraud in federal healthcare programs

✓ Recognize elements of healthcare fraud violations

✓ Understand compliance plans that prevent false claims

✓ Avoid False Claims Act violations in daily work

✓ Know whistleblower roles and legal protections available

Course Content

Lesson 1: Introduction & Objectives

Course overview and learning objectives, magnitude of healthcare fraud problem ($300 billion annually), impact on healthcare costs and insurance premiums, importance of compliance for all healthcare workers

Lesson 2: Defining Fraud and Abuse

Distinguishing fraud from abuse, intentional vs. unintentional violations, examples of common fraud schemes, examples of waste and abuse, consequences of fraud and abuse violations

Lesson 3: Laws Combating Healthcare Fraud

  • False Claims Act (31 USC § 3729) – Liability for false claims submitted to government, qui tam provisions, penalties and treble damages
  • Anti-Kickback Statute (42 USC § 1320a-7b(b)) – Prohibition on remuneration for referrals, safe harbors, criminal and civil penalties
  • Physician Self-Referral “Stark” Law (42 USC § 1395nn) – Prohibition on self-referrals for designated health services, exceptions, strict liability standard
  • Fraud Enforcement and Recovery Act of 2009 (FERA) – Expanded False Claims Act liability, reverse false claims
  • Patient Protection and Affordable Care Act – Enhanced screening, enhanced penalties, expanded enforcement tools
  • Deficit Reduction Act of 2005 (DRA) – Employee education requirements, state false claims acts

Lesson 4: Compliance Plans and Preventing False Claims Act Violations

Seven elements of effective compliance programs, code of conduct, designated compliance officer, effective training and education, effective lines of communication, internal monitoring and auditing, enforcing standards through disciplinary guidelines, responding to detected offenses, employee responsibilities in preventing violations

Lesson 5: Role of Whistleblowers in False Claims Act Suits

Qui tam lawsuits under False Claims Act, whistleblower eligibility and rewards (15-30% of recovery), protection from retaliation, reporting procedures, confidentiality protections, examples of successful whistleblower cases

Who This Course Is For

🏥 All Healthcare Employees

Clinical and administrative staff at all levels

👨‍⚕️ Healthcare Providers

Physicians, nurses, and allied health professionals

💼 Healthcare Administrators

Management and operations staff

📋 Billing and Coding Staff

Personnel involved in claims submission

🔍 Compliance Officers

Staff responsible for compliance program oversight

🏢 Healthcare Executives

Leadership setting organizational compliance culture

Certificate & Compliance

Upon successful completion, learners receive an official certificate documenting their Medicare fraud and abuse training. This certificate demonstrates compliance with federal requirements for fraud and abuse education under the Deficit Reduction Act and supports organizational compliance program requirements.

The course includes a comprehensive assessment that verifies understanding of fraud and abuse laws, compliance obligations, and reporting responsibilities. Certificates are generated immediately and can be downloaded or printed for compliance records.

Supports Compliance With:

  • False Claims Act (31 USC § 3729)
  • Anti-Kickback Statute (42 USC § 1320a-7b(b))
  • Stark Law (42 USC § 1395nn)
  • Fraud Enforcement and Recovery Act (FERA)
  • Patient Protection and Affordable Care Act
  • Deficit Reduction Act of 2005 (DRA) employee education requirements
  • OIG Compliance Program Guidance
  • CMS compliance training requirements

Choose How Your Team Learns

🖥️ Use Our LMS

Immediate access with zero setup

  • Fast & Easy Setup

  • Automatic progress tracking and reporting

  • Built-in certificate generation

  • No technical expertise required

  • Automated Course Recertification

📦 Use Your Own LMS

Purchase SCORM files for your system

  • Integrate with your existing platform

  • Maintain centralized training records

  • Compatible with all major LMS platforms

  • Full technical specifications provided

  • Dedicated support included

Why Choose Evolve?

🎯

Expert-Developed Content

Courses feature realistic scenarios, engaging multimedia, and knowledge checks to reinforce learning. Content developed by compliance experts ensures accuracy and relevance.

📱

Accessible Anywhere

Complete training anytime, anywhere on PCs, tablets, or smartphones. Your team can learn at their own pace without disrupting daily operations or scheduling conflicts.

🎬

Engaging & Effective

Scenario-based learning & interactive elements promote retention better than lecture-style courses

📊

Trackable and Reportable

Monitor completion rates, track progress, and generate compliance reports. Maintain detailed records for audits and regulatory requirements.

💰

Transparent Pricing

Simple per-seat pricing with no hidden fees, surprise charges, or mandatory bundles. Volume discounts make compliance training affordable for organizations of any size.

⚡

Easy Implementation

Begin training your team immediately – no lengthy implementation or waiting periods

📈

Scalable Solutions

Whether training 5 employees or 500, our platform scales to meet your organization’s needs. Custom course bundles available to address your specific training requirements and budget.

✓

Consistent Quality Training

Every learner receives the same high-quality, up-to-date content. Standardized training ensures your entire organization maintains consistent compliance knowledge.

💬

Ongoing Support

Dedicated customer support available to assist with questions, technical issues, or training customization needs.

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SAFEGUARD AGAINST HEALTHCARE FRAUD

Essential Training to Protect Your Organization from $300 Billion Annual Problem

Healthcare fraud costs the system $820 million every single day. Organizations that fail to train staff on fraud and abuse laws face severe penalties including multimillion-dollar fines, exclusion from Medicare and Medicaid programs, and potential criminal prosecution. The Deficit Reduction Act requires healthcare organizations receiving federal payments to educate employees about fraud and abuse laws and whistleblower protections. This 40-minute course fulfills that requirement while protecting your organization from the devastating financial and reputational consequences of fraud violations.

Trusted by healthcare organizations nationwide to meet DRA requirements and build strong compliance cultures