Healthcare Fraud Prevention: Avoiding Improper Referrals, Kickbacks and Claims
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At a glance
Healthcare fraud is costly. In fact, tens of billions of dollars are lost each year due to healthcare fraud. Fortunately, employees at every level are in a position to prevent this – if they understand and follow key guidelines.
Healthcare Fraud Prevention: Avoiding Improper Referrals, Kickbacks and Claims helps employees recognize and prevent the most common types of healthcare fraud: physician self-referrals (Stark Law), kickbacks and false claims. Coverage also includes an overview of important, preventive, day-to-day best practices that focus on accuracy, documentation and knowledge of organizational policies and the law.
It’s critical that organizations take an active role in healthcare fraud prevention. Proper training will give employees the tools to understand and abide by the policies and laws that cover this important topic.
Key concepts covered in this course:
- Definitions of fraud, waste and abuse – and what they can look like
- Correction and corrective planning that may be involved if fraud, waste or abuse is detected
- Key indicators of fraud, waste and abuse
- A brief overview of the Physician Self-Referral Law, or Stark Law
- Key terms under the law, including designated health service, immediate family member, financial relationship and exception
- Penalties for improper referrals
- Brief overviews of key laws, like the Anti-Kickback Statute and the Stark Law
- Examples of safe harbors
- Penalties for involvement with kickbacks
- A brief overview of the False Claims Act
- Common types of false claims
- Best practices for accurate certifications
- The importance of making reports of suspected misconduct
- Understanding and following policies and procedures
- Ensuring complete and accurate medical and billing records
- Documenting financial relationships
- Seeking clarification as necessary
- Reporting suspected misconduct
- Review of the critical role employees play in speaking up about illegal or unethical behavior
- An opportunity to review key policies and certify