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Medicare Compliance: Fraud and Abuse
Who Should Take This Course
This course was developed for all employees and level of management working in healthcare organizations who need to know the fundamental rules rules regarding healthcare fraud and abuse.
What is Covered
This course provides a review of the laws that are used to combat fraud and abuse against government healthcare programs including:
- False Claims Act - 31 USC ss 3729 (FCA)
- Anti- Kickback Statute - 42 USC 1320-7b(b)
- Physician Self-Referral (“Stark”) Statute - 42 USC 1320-7b(b)
- Fraud Enforcement and Recovery Act of 2009 ("FERA")
- Patient Protection and Affordable Care Act
- Deficit Reduction Act of 2005 (DRA)
- Describe the differences between healthcare fraud and abuse.
- Describe the principle laws that are used to combat fraud and abuse against federal government healthcare programs.
- Identify the elements of healthcare fraud.
- Describe a compliance plan so employers can prevent false claims.
- Describe how employees can avoid False Claims Act violations.
- List the role of whistleblowers in False Claims Act suits and how they are protected.
- Lesson 1 - Introduction and Objectives
- Lesson 2 - Defining Fraud and Abuse
- Lesson 3 - Laws Combating Healthcare Fraud
- Lesson 4 - Compliance Plans and how Employees Can Prevent False Claims Act violations
- Lesson 5 - Role of Whistleblowers in False Claims Act suits