Medicare Fraud, Waste, and Abuse Training

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.

FAQs

What is Medicare Fraud and Abuse?

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. With Medicare and Medicaid, fraud is when someone knowingly deceives, conceals, or misrepresents to obtain money or property from any health care benefit program.

What Does Medicare Fraud, Waste, and Abuse Training Include?

CMS 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 Do I Get Fraud, Waste, and Abuse Training?

There are a few avenues you can take, but one of the most time and cost-effective ways is through a recognized third party. HIPAA Exams is one such third party. We provide an online course to help you better understand CMS fraud, waste, and abuse in the healthcare sector.

Can I Take Medicare Fraud Training Online?

Yes. Equip yourself and your employees with everything there is to know about Medicare fraud and abuse with HIPAA Exams' fully online training.

How Long Does Medicare Fraud and Abuse Training Take?

We understand how busy life in the healthcare industry can be, that is why we make it so easy to complete training. We estimate it will take you at least 60 minutes to finish our online training course.

How Long Does Medicare Fraud Training Last?

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.

Although there is no set requirement regarding the frequency of training, it is industry best practice for all newly hired staff to get training immediately. Then, annual training is recommended to ensure compliance with HIPAA regulations.

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

HIPAA noncompliance can lead to high costs. The HHS Office for Civil Rights may fine healthcare organizations between $141 and $2,134,831 per violation if they don’t provide proper HIPAA training. These fines are not the only risk; organizations may also face action plans to correct issues, possible lawsuits, or other civil penalties.

Although CMS doesn’t directly penalize organizations for HIPAA violations, noncompliance can still impact CMS accreditation and funding, especially for facilities that rely on Medicare and Medicaid. To avoid these problems, healthcare organizations should provide regular HIPAA training for all employees, especially those handling protected health information (PHI), and keep records of the training.

What Is Considered CMS Fraud?

According to CMS, healthcare fraud involves fabricating facts to persuade healthcare providers to pay for services or medical care. 

A major example of this would be medical identity theft, where a person obtains medical supplies, services, or funds by using another person's medical card or personal information. Intentionally lying, hiding, or misrepresenting information to receive funds or assets from a health care benefit program is another common example.

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

Healthcare fraud, waste, and abuse are significant issues affecting the healthcare industry, making it crucial to understand their differences: 

• Fraud - The deliberate withholding of information or deceit from a health insurance provider in order to get an unapproved payment or benefit is known as fraud.
• Waste - Waste in healthcare occurs when a patient uses medical services excessively and carelessly.
• Abuse - Behaviors that violate professional standards of conduct or are incorrect, inappropriate, or medically unnecessary are considered healthcare abuse.

What Are the Examples of Fraud and Abuse in Healthcare?

Unfortunately, there are plenty of examples of fraud and abuse in healthcare. Here are five of the most common occurrences: 

• Billing for Unprovided Goods or Services - Medicaid fraud schemes include upcoding medical procedures and charging for treatments and procedures that were not conducted. This leaves patients in the dark about the full scope of services rendered. 
• Paying Kickbacks - A kickback occurs when a healthcare professional uses payment or other benefits to persuade a patient or another healthcare professional to recommend them to their office or institution.
• Billing for Medically Unnecessary Tests - Some providers scam patients by misrepresenting diagnosis and symptoms on patient records, then submitting invoices to insurance companies for higher reimbursement rates. 
• Double Billing - When a provider is paid for the same service by several organizations, including insurance companies, pharmaceutical firms, insurers, or government programs, this is known as double billing.
• Consumer Deception Fraud - Patients and consumers commit fraud by using insurance cards, identifying non-relatives, claiming unreceived services, and staging accidents.

What are the course completion requirements to earn CEUs?

To successfully complete the course and earn Continuing Education Units (CEUs), you must:

• Complete the required time within the course curriculum before the course is considered finished.
• Validate your identity at designated checkpoints throughout the course.*
• Pass all quizzes and the final exam with a minimum score of 70% within three attempts or fewer before a certificate of completion can be issued and CEUs can be awarded.**

*How is identity validated during the course?

360training verifies each learner’s identity through periodic validation questions during the learning event. At the beginning of the course, learners are prompted to answer a series of personal validation questions. These responses are securely saved in the Learning Management System (LMS).

• What is your childhood nickname?
• What is the name of your favorite childhood friend?
• What is your oldest cousin’s first name?

Throughout the course, the LMS will prompt learners to answer these validation questions at preset intervals (e.g., every ten minutes).

• If a learner answers correctly, they are allowed to continue.
• Incorrect responses may result in the learning event being temporarily locked.

This process ensures the individual completing the course is the same person who enrolled.

**How are CEUs calculated?

Upon successful completion of the course requirements, CEUs will be awarded according to the following standard:

• 10 hours of education = 1.0 CEUs
• 30 hours of education = 3.0 CEUs
• 5 hours of education = 0.5 CEUs

Important: Partial credit or adjusted CEUs are not awarded. Learners must fully meet all course requirements, including identity validation, time-in-course, and passing scores, to receive CEUs.