Course Description:
downstream Medicare Part C and Part D contractors regarding the Federal laws and guidelines related to fraud, waste and abuse. This program is designed to meet the Medicare Fraud, Waste and Abuse Guidance, developed by the Centers for Medicare & Medicaid Services requiring Part C and Part D sponsors to implement a comprehensive program to detect, correct and prevent fraud, waste and abuse (FWA). The guidance establishes core elements of a compliance program for the Part C and D benefit, and provides guidance to contractors on how to develop a comprehensive fraud, waste and abuse program or to integrate a program into an existing compliance plan.
Course Objective:
At the completion of this program, you should be able to:
- Identify general fraud, waste and abuse, and understand when and how to report fraud, waste and abuse to the Medicare program.
- Describe your protections as an employee when reporting fraud, waste and abuse.
- Identify general federal health care fraud standards, laws and policies.
- Identify upcoding, unbundling and non-rendered and/or medically unnecessary services: the most prevalent forms of fraud and abuse related to coding.
- Identify various types of enrollee fraud.
- Identify your organization’s health care fraud policies and procedures, and explain the procedure for reporting fraud.
- Describe the consequences for non-compliance.
- Certify that you have reviewed your organization’s policies and procedures related to fraud, waste and abuse.
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