• Online, Self-Paced
  • Classroom
  • Online, Instructor-Led
Course Description

Every year billions of dollars are improperly spent because of FWA. It affects everyone – including you. This training will help you detect, correct, and prevent FWA. You are part of the solution. Combating FWA is everyone’s responsibility! As an individual who provides health or administrative services for Medicare enrollees, every action you take potentially affects Medicare enrollees, the Medicare Program, or the Medicare Trust Fund. All Part C and D first tier, downstream, related entities (FDR), including Medicare Advantage organization (MAO) who administer the Part D drug benefit or provide health care services to Medicare Advantage enrollees. Targeted audience for this course is basically from Hospitals, Private Clinics, Doctors, Physicians, Nurses, Medical Schools, Medical Students, Medical Office Staff, Dentists, Chiropractors, Physical Therapists, Massage Therapists, Radiologists, Cardiologists, Hospice, Nursing Homes, Home Health, Durable Medical Equipment providers, etc., Mental Health Providers, Pharmacy Benefit Managers (PBMs), Pharmacies and pharmacists, medical health plans, dental, vision, flexible spending accounts that work with MA part part D programs, Claim Processing Firms, etc

Learning Objectives

  • Introduction
  • Definitions
    • Fraud
    • Waste
    • Abuse
    • Additional Definition
  • Enforcement Agencies
  • Governing Laws
    • Civil and Criminal False Claims
    • Anti-Kickback Act
    • Civil Monetary Penalties Act
    • Ethics in Patient Referrals Act
    • Health Care Fund
    • Criminal False Statements Related to Health Care Matters
    • Civil False Claims Act
    • Obstruction of Criminal Investigations of Health Care Offense
  • The Impact of Non-Compliance
  • Whistleblower Protection Act
  • What is a Compliance Plan?
  • Fraud, Waste and Abuse Examples
    • Prescriber Examples
    • Beneficiary Examples
    • Pharmaceutical Manufacturer Examples
    • Plan Sponsor Examples
    • Pharmacy Benefits Manager (PBM)/Pharmacy Examples
    • Billing Examples
    • Common Types of Health Care FWA
  • Fraud Warning Signs
  • Consequences of Committing Fraud, Waste or Abuse
  • Reporting Fraud, Waste, and Abuse
  • The Importance of Awareness & Training
  • Red Flag Rule Overview
  • Required Actions for Healthcare Entities
  • Summary

Framework Connections

The materials within this course focus on the Knowledge Skills and Abilities (KSAs) identified within the Specialty Areas listed below. Click to view Specialty Area details within the interactive National Cybersecurity Workforce Framework.