FRAUD & ABUSE
What is the biggest difference between fraud and abuse?
Fraud is intentional deception.
Abuse is improper practice that may be unintentional.
What does the Stark Law prohibit?
Physicians referring Medicare/Medicaid patients for designated health services to entities where they have a financial relationship unless an exception applies.
What does PHI stand for?
Protected Health Information.
What should you do first when an employee raises a compliance concern?
Listen.
How soon should an employee report an incident?
Immediately.
Billing for services that were never provided is an example of what?
Fraud
Is the Anti-Kickback Statute intent-based?
Yes
True or False:
PHI only exists in electronic medical records.
False.
Should supervisors investigate concerns on their own?
No
Incident reports should be completed within how many hours?
24 hours.
Name TWO examples of abuse.
Name two requirements of an equipment rental Safe Harbor.
Name four examples of PHI.
True or False:
Employees should never be retaliated against for reporting concerns in good faith.
True.
Name three incidents that should be reported.
Abuse can still result in penalties even if there was no intent to deceive.
True
Failure to meet every Safe Harbor automatically means you violated the AKS.
False.
Who has rights to their health information under HIPAA?
Patients.
Name three supervisor responsibilities.
What should you avoid when completing an incident report?
Making assumptions.
List three possible consequences of healthcare fraud.
Which statement is compliant?
A. "Can you send us more patients?"
B. "Ownership means we'd expect more referrals."
C. "Let's discuss staffing needs and scheduling."
D. "More referrals mean a better investment."
C. "Let's discuss staffing needs and scheduling."
Name three different formats where PHI can exist.
Compliance training is required:
A. Every five years
B. For new hires and annually
C. Every two years
D. Only for new employees
After an incident report is submitted, name two things that may happen.