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.