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

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):