CMS Fraud, Waste and Abuse Training



Toll Free
9AM - 5PM CST (M-F)

Faculty: Donna L Atherton RN, MSN, NP and Diane Leis MA


Successful Completion: Complete entire module, complete the exam with a passing score of 80% or better, and complete the evaluation form.


Estimated Time to Complete Activity: 60 minutes.


CEUs: HIPAA Exams is authorized by IACET to offer 0.1 CEUs for this program. CEU Information


Free Certification of Completion available instantly for download or printing upon successful completion.


Broaden your knowledge of CMS fraud, waste and, abuse in the health care environment.

Course includes a video and audio component with stand-alone exam.


What is CMS fraud?

CMS (Centers for Medicare & Medicaid Services) fraud includes intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to themselves or someone else. In relation to Medicare and Medicaid, fraud is when someone knowingly deceives, conceals, or misrepresents to obtain money or property from any health care benefit program.

What are the CMS fraud, waste, and abuse training requirements?

CMS (Centers for Medicare and Medicaid Services) fraud, waste, and abuse training requirements are designed to increase awareness and understanding of the concerns around fraudulent and wasteful practices within the healthcare system, particularly within Medicare and Medicaid services.

The training requirements include:

  • How to recognize fraud, waste, and abuse (FWA)
  • How to prevent and report FWA
  • Understand the consequences and penalties

How often do CMS require HIPAA training?

CMS (Centers for Medicare and Medicaid Services) mandates HIPAA (Health Insurance Portability and Accountability Act) training for all healthcare organizations, including those under its administration. When it comes to the frequency of training, while there's no specific mandate, the industry best practice is that all new employees receive immediate training upon hire. Then, annual training is recommended to ensure compliance with HIPAA regulations.

What is the penalty for not having HIPAA training for CMS?

The penalties for not complying with HIPAA regulations, which include lacking proper training, can vary depending on the level of culpability. Civil monetary penalties can range from $137 to $68,928 per violation, with annual maximums depending on the level of violation ($2+ million). Criminal penalties can also be imposed for intentional violations, leading to fines and potential imprisonment.

What Is Considered CMS Fraud?

Deliberately providing false information to get healthcare providers to pay for medical care or services is known as CMS fraud. A common example of CMS fraud is medical identity theft, where someone uses another's medical card or personal information to obtain medical supplies, services, or money.

What Is the Difference Between Healthcare Fraud, Waste, and Abuse?

In the United States, healthcare fraud, waste, and abuse impacts everyone. That is why it is so important to understand the differences between the three:

  • Fraud is defined as the intentional concealment of facts or deception to a health insurance provider with the purpose of getting an unauthorized payment or benefit.
  • Waste is when a patient recklessly overuses healthcare services.
  • Abuse is defined as behaviors that are not in line with professional norms of conduct, improper, inappropriate, or medically unnecessary.

What Are the Examples of Fraud and Abuse in Healthcare?

Examples of fraud include submitting fictitious claims for services, fabricating medical records, misrepresenting services, overcharging, faking eligibility, and neglecting to disclose coverage under other health insurance plans.

 Abuse can take many different forms, including waiving cost-shares or deductibles, neglecting to keep adequate financial or medical records, submitting fictitious claims, and denying access to necessary documents.

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Learning Objectives

  • Identify the mandatory laws governing Medicare fraud and abuse.
  • Describe your part in preventing Medicare CMS fraud, waste, and abuse.
  • Summarize what you can do to detect, correct, and prevent fraud, waste, and abuse.

Table of Contents

CMS Fraud, Waste and Abuse Training 2019

Table of Contents:

  • CMS Fraud, Waste, and Abuse
  • Legal Notice
  • Purpose and Learning Objectives
  • Target Audience
  • The Social Security Act and Centers for Medicare & Medicaid Services (CMS) Regulations and Guidance
  • CMS and the Social Security Act: Regulations and Guidance
  • AFA Mandatory Compliance Program
  • An Effective Compliance Program
  • Components of an Effective Compliance Program
  • Fraud, Waste, and Abuse: What are they?
  • Fraud, Waste, and Abuse
  • Examples of Fraud, Waste, and Abuse
  • Federal Health Care Fraud and Abuse Laws
  • False Claim Act (FCA)
  • Anti-Kickback Statute (AKS)
  • Stark Law
  • Exclusion Statue
  • Summary
  • End of Course Quiz


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