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Medicare Compliance
Course Length: 60 minutes
This one-hour course (i) provides an overview of the Medicare system, (ii) outlines the Compliance Plan required by CMS, (iii) reviews the rules on conflicts of interest and business gifts, and (iv) explains how employees can help detect, correct and prevent fraud, waste and abuse.
It's estimated that 3% to 10% of all healthcare-related spending — some $67 billion to $230 billion — is lost to fraud, waste or abuse each year. Indeed, healthcare fraud is believed to be the second largest white-collar crime in the U.S.
Medicaid Services (CMS) requires organizations that provide healthcare or administrative services for Medicare-eligible individuals under a Medicare Advantage (Part C) or prescription-drug plan (Part D) to train all employees annually on compliance awareness, conflicts of interest, and the prevention of fraud, waste and abuse.
This one-hour course (i) provides an overview of the Medicare system, (ii) outlines the Compliance Plan required by CMS, (iii) reviews the rules on conflicts of interest and business gifts, and (iv) explains how employees can help detect, correct and prevent fraud, waste and abuse.
The topics covered in this course include:
- What is Medicare?
- CMS compliance essentials
- Overview of the Compliance Plan
- Employee responsibilities
- Penalties for noncompliance
- Conflicts of interest
- Giving and receiving gifts and business courtesies
- Overview of Medicare fraud, waste and abuse
- Types of fraud
- Anti-fraud laws
- Penalties for fraud
- Reporting violations
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