Fraud – Is the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s).
Fraud involves making false statements or misrepresentation of material facts in order to obtain some benefit or payment for which no entitlement would otherwise exist. The acts may be committed for the person’s own benefit or for the benefit of another party. In order to be considered fraud, the act must be performed knowingly, willfully and intentionally.
Waste – An attempt to obtain reimbursement for items or services where there was no intent to deceive or misrepresent, but the outcome of a billing error caused unnecessary costs to the involved companies. Waste includes overutilization of services not caused by criminally negligent actions. Waste also involves the misuse of resources.
Waste means over-utilization of services, or practices that result in unnecessary costs. Waste also refers to useless consumption or expenditure without adequate return, or an act or instance of wasting.
Abuse – Describes provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in:
It also includes recipient practices that result in unnecessary cost to the Medicaid and Medicare program. Abuse is similar to fraud except that there is no requirement to prove or demonstrate that abusive acts were committed knowingly, willfully and intentionally.
Every year billions of dollars are improperly spent because of FWA. It affects everyone – including you. This training will help you detect, correct, and prevent FWA. You are part of the solution. Combating FWA is everyone’s responsibility! As an individual who provides health or administrative services for Medicare enrollees, every action you take potentially affects Medicare enrollees, the Medicare Program, or the Medicare Trust Fund.
All Part C and D first tier, downstream, related entities (FDR), including Medicare Advantage organization (MAO) who administer the Part D drug benefit or provide health care services to Medicare Advantage enrollees.
This training module will assist Medicare Parts C and D plan Sponsors employees, governing body members, and their first-tier, downstream, and related entities (FDRs) in satisfying the annual Fraud, Waste, and Abuse (FWA) training requirements in the regulations and sub-regulatory guidance at:
Sponsors and their FDRs may use this module to satisfy FWA training requirements. Sponsors and their FDRs are responsible for providing additional specialized or refresher training on issues posing FWA risks based on the employee’s job function or business setting
New employees must complete the training within 90 days of hire. All employees must complete it annually thereafter.
Compliance is everyone’s responsibility. An effective compliance program fosters a culture of compliance. To help ensure compliance, behave ethically and follow your organization’s and the Plan’s Standards of Conduct. Watch for common instances of non-compliance, and report suspected non-compliance. Know the consequences of non-compliance, and help correct any non-compliance with a corrective action plan that includes ongoing monitoring and auditing
Students can buy 1.5 CE credits certificate for this course at the time of registration. You will receive one CE credit for this course through Approved Provider of California Board of Registered Nursing after completing the course.
Email us now at Bob@training-hipaa.net or call (515) 865-4591 if you have any questions about this course and who should take this course.