Healthcare Fraud Prevention: Avoiding Improper Referrals, Kickbacks and Claims

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