Compliance, Ethics, and Fraud for Health Care Workers

Table of Contents:

• Compliance, Ethics, and Fraud
• Legal Notice
• Purpose and Learning Objectives
• Target Audience
• Compliance and Ethics in Health Care
• Mandatory Compliance
• Effective Compliance Program
• Components of an Effective Compliance Program
• Ethical Business Practices: Interactions with Health Care Professionals
• Integrity, Independence, Transparency
• Federal Health Care Fraud and Abuse Laws
• False Claim Act (FCA)
• Anti-Kickback Statue (AKS)
• Stark Law
• Exclusion Statue
• Summary
• End of Course Quiz

Course Content Example 1:

 Integrity, Independence, Transparency

The Department of Health and Human Services, Office of the Inspector General (OIG) mandates ethical business practices.

Companies must:

• Ensure the collaborative relationships with health care professionals meet high ethical standards
• Relationships must be conducted with appropriate transparency and in compliance with applicable laws, regulations and government guidance.
• Medical decisions must be based on the best interests of the patient
• Not provided inappropriate inducements to health care professionals of any monetary value, including gifts, entertainment, commissions or gratuities.
• Ensure that promotional and marketing materials on drugs or devices must be based on scientific evidence and not false information.

Course Content Example 2: 

Integrity, Independence, Transparency

Prohibition of Gifts

Provide only items to Health Care Professionals (HCPs) that benefit patients or serve a genuine educational function for HCP.

• Other than medical textbooks or anatomical models, any item should have a fair market value of less than $100.00

Non-Educational branded promotional items may not be given, even if minimal value.

• No cookies, wine, flowers, chocolates, gift baskets, holiday gifts, cash or cash equivalent may be given