Course Overview
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 NICE Framework Task, Knowledge, and Skill statements identified within the indicated NICE Framework component(s):