Medicare | Medicaid Financial

Federal and State funded healthcare programs have their own regulations and
requirements requiring training and awareness

Corporate compliance training discusses and identifies the goals of having an effective corporate compliance program. An effective corporate compliance program will include standards that can help stress the importance of fraud awareness, HIPAA guidelines, OIG compliance in a managed care setting, and proper coding and documentation. The overview includes addressing compliance risk areas, billing and reimbursement issues, resident care risk areas, and patient confidentiality.

Course Objectives:

  • Explain the necessary elements of a corporate compliance program.
  • Identify the common compliance risk areas associated with healthcare settings.
  • Recognize specific strategies the OIG uses in managed care settings.

Duration: 1 hour. CE Credits: 1 Chapter: 4

Congress has enacted important legislation that has helped to reduce the deficit by reducing outlays from direct spending by approximately $39 billion. This course summarizes specific provisions under the Deficit Reduction Act and explains how these changes have been passed on to taxpayers. The course also provides an overview of the False Claims Act and how it pertains to fraud and abuse in the Medicare and Medicaid programs. As part of the False Claims Act, Congress has also enacted important legislation, Employee Protection Act, which protects employees who help fight fraud and abuse within the government.

Course Objectives:

  • Explain the Deficit Reduction Act/False Claims Act/Employee Protection Act and how they pertain to fraud and abuse in the Medicare and Medicaid programs.
  • List the general provisions and the legislative changes of the Deficit Reduction Act that were enacted by Congress.
  • Examine certain benefits that the Deficit Reduction Act has on State programs.
  • Gain an in-depth understanding of how this legislation affects Medicaid and the uninsured.
  • Know specific provisions relevant to documentation requirements, prescription drugs, asset transfers, targeted case management and other notable Medicaid reforms.
  • Learn how the False Claims Act helps to prevent fraud and abuse in Medicaid and Medicare.
  • Understand relevant employee protection statutes associated with the False Claims Act.

Duration: 90 min. CE Units: 1.5 Chapters: 3

The Federal Anti-Kickback Statute applies to all persons that participate in healthcare programs including providers, vendors, employees, and patients. This course will provide an overview of the law to identify and report suspected violations.
The Federal Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals or generate Federal healthcare program business. The statute requires there to be an intentional and willful act to break the law. The fine may contain criminal and civil penalties ranging from $25,000 to $50,000 per violation, up to five years in prison, and civil penalties equal to three times the amount of the kickback. There are a few voluntary safe harbors – which provide relief for “specific” types of transactions exempt from the law.

Course Objectives:

  • Overview of the Federal Anti-Kickback statute.
  • Learn how to identify and report suspected violations.

Duration: 15 min. CE Credits: .25 Chapters: 1

The Medicare Fraud, Waste, and Abuse training program is designed to inform employees of potential issues that can lead to fraud, waste, and abuse within the Medicare building procedures and system. The training will help employees identify how to spot fraud, waste, or abuse; what do about fraudulent situations, and how to prevent and report such situations.

Course Objectives:

  • Overview of the benefits provided by medicare.
  • Examples of fraud and abuse.
  • Laws that are in place to fight fraud and abuse.
  • strategies and programs in place and how to access and utilize them to combat fraud and abuse.

Duration: 1 hour. CE Credits: 1 hr Chapters: 4

Fraud, Waste and Abuse training is divided into two parts: (1) Medicare Parts C & D Fraud, Waste and Abuse (FWA), and (2) Medicare Parts C & D General Compliance Training. All persons who provide health or administrative services to Medicare enrollees must satisfy general compliance and FWA training requirements. This module may be used to satisfy both requirements.

Course Objectives:

  • Meet the regulatory requirement for training and education.
  • Provide information on the scope of fraud, waste, and abuse.
  • Explain the obligation of everyone to detect, prevent, and correct fraud, waste, and abuse.
  • Provide information on how to report fraud, waste, and abuse.
  • Provide information on laws pertaining to fraud, waste, and abuse.

Duration: 15 min. CE Credits: .25 hr Chapters: 1

The course provides an overview of Stark Law guidelines that prohibit a physician from referring Medicare patients to an entity with which the physician (or immediate family member) has a financial relationship, and prohibits the designated health services entity from submitting claims to Medicare for prohibited referral services.

Course Objectives:

  • Review the foundational principles of the law, exemption examples, and recent changes to regulation.
  • Discuss additional financial issues and requirements in the area of investments and other forms of compensation.

Duration: 30 min. CE Credits: .50 Chapters: 2