CMS Fraud, Waste and Abuse Training
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8 AM - 4 PM MST (M-F)
Faculty: Donna L Atherton RN, MSN, NP and Diane Leis MA
Broaden your knowledge of fraud, waste and, abuse in the health care environment.
Course includes a video and audio component with stand-alone exam
This demo video is a small example of this course’s content, it is not representative of the full course and the level of engagement required.
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- Identify the mandatory laws governing Medicare fraud and abuse.
- Describe your part in preventing Medicare 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
- End of Course Quiz
Course Content Example 1:
Components of an Effective Compliance Program
- Commitment by the organization’s senor leadership for an effective compliance and ethics program.
- Policies and Procedures. Written standards and procedures to reduce criminal, civil, and administrative violations.
- Should be tailored to fit specific risk assessment conducted by your organization to identify risk areas faced in the healthcare arena.
- Chief Compliance Officer. A high-ranking individual in the organization should be designated responsible for the compliance program.
- The officer should possess resources and authority to implement the program and should report to the senior leadership of the company.
Course Content Example 2:
Examples of Fraud, Waste, and Abuse
Questions to ask:
- Does the manufacturer promote off label drug usage?
- Does the manufacturer provide samples, knowing that the samples will be billed to a federal health care program?
- Does the prescription look altered or possibly forged?
- Is the prescription appropriate based on beneficiary’s other prescriptions?
- Does the beneficiary’s medical history support the services being requested?
- Is the provider writing for a higher quantity than medically necessary for the condition?
- Is the provider performing unnecessary services for members?
Course Content Example 3:
Stark Law prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies
Financial relationships include:
- Ownership/investment interests
- Compensation arrangements
Instant Certificate Of Completion Printing Upon Successful Completion Of CMS Fraud, Waste and Abuse Training
Free Retakes on Exam Until You Pass
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