Compliance, Ethics, and Fraud for Health Care Professionals

The course covers essential federal laws, including the False Claims Act, Anti-Kickback Statute, and Stark Law for healthcare professionals.

FAQ's

How Does Healthcare Fraud Violate HIPAA?

Healthcare fraud can violate many different federal, state, or local laws, but HIPAA isn’t one of them.

HIPAA violations are typically related to breaches of privacy. If you disclose or fail to adequately guard Protected Health Information (PHI), you may be guilty of a HIPAA violation.

Healthcare fraud would be a violation of some other law(s).

How Does HIPAA Prevent Fraud and Abuse?

HIPAA isn’t primarily focused on preventing fraud and abuse, but Title II created several programs to control fraud and abuse in both public and private health plans.

For example, it established the national Health Care Fraud and Abuse Control (HCFAC) Program to coordinate law enforcement efforts related to health care fraud and abuse.

HIPAA also has provisions to allow the sharing of Protected Health Information (PHI) in the context of a fraud investigation, so that covered entities can report fraud without violating privacy rules.

How Does HIPAA Define Fraud?

HIPAA defines insurance fraud as an intentional deception or misrepresentation that someone makes that could result in an unauthorized payment while knowing it is false.

Which Organization Did HIPAA Authorize to Investigate Cases of Health Care Fraud?

The Health Care Fraud and Abuse Control (HCFAC) Program, which was created by HIPAA, is under the joint direction of the Attorney General (under the Department of Justice or DOJ) and the Office of the Inspector General under the Department of Health and Human Services (HHS-OIG).

The investigations themselves are carried out by various federal, state, and local law enforcement agencies – primarily the FBI. However, the HCFAC coordinates these activities and collects related data.

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.