PROGRAM 

Most healthcare providers strive to work ethically, provide high-quality care to their residents, and submit proper claims for payment. Although no precise measure of health care fraud exists, those intent on abusing state and federal health care programs can cost taxpayers billions of dollars while putting beneficiaries’ health and welfare at risk. Medicare fraud and abuse increases the financial strain on the Medicare Trust Fund. The impact of these losses and risks magnifies as Medicare continues to serve a growing number of people.

You play a vital role in protecting the integrity of the Medicare Program. To combat fraud and abuse, you need to know how to protect your organization from engaging in abusive practices and civil or criminal activity. Success in this effort is essential to maintaining a healthcare system that is affordable for everyone.

CEU- 3.0

• Administrator 
• Social Worker

TARGET AUDIENCE

• Administrators
• Billing Office
• Social Worker

OBJECTIVES

1. Learn the definition of fraud, waste and abuse
2. Learn about Office of Investigation
3. Learn about false claims and  billing unnecessary treatment 
4. Learn fraud indicators, detection, prosecution, and recovery
5. Learn Physician Self-Referral Law (Stark Law) and its application to long-term care
6. Learn anti-kickbacks
7. Learn suspension of payment 
8. Learn staff education and responsibility for reporting Medicare, Medicaid, Fraud, Waste and Abuse