Combating Medicare Parts C And D Fraud, Waste, And Abuse - 2018

Bribes or kickbacks of any kind for services that are paid under a Federal healthcare program (which includes Medicare) constitute fraud by the person making as well as the person receiving them.

Once a corrective action plan is started, the corrective actions must be monitored annually to ensure they are effective.

Any person who knowingly submits false claims to the Government is liable for five times the Government's damages caused by the violator plus a penalty.

Waste indicates any misuse of resources such as the overuse of services, or other practices that directly or indirectly result in unnecessary costs to the Medicare Program.

These are examples of issues that should be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA); potential health privacy violation; and unethical behavior/employee misconduct.

Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.

Ways to report fraud, waste, and abuse (FWA) include: A. Telephone hotlines B. Mail drops C. In-person reporting to the compliance department/supervisor D.Special Investigations Units (SIUs)

These are examples of issues that can be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA); potential health privacy violation; and unethical behavior/employee misconduct.

Some of the laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA); the False Claim Act; the Anti-Kickback Statute; the List of Excluded Individuals and Entities (LEIE); and the Health Care Fraud Statute.

You can help prevent fraud, waste, and abuse (FWA) by doing all of the following: Look for suspicious activity Conduct yourself in an ethical manner Ensure accurate and timely data/billing Ensure you coordinate with you payers Keep up to date with FWA policies and procedures, standards of conduct, and Medicare & Medicaid Services (CMS) guidance Verify all information provided to you

What are some of the penalties for violating fraud, waste, and abuse (FWA) laws? A. Civil Monetary Penalties B. Imprisonment C. Exclusion from participation in all Federal healthcare programs