Fraud, Waste & Abuse
What is fraud?
Intentional deception to receive payment or benefit
What does the Anti-Kickback Statute prohibit?
Offering, paying, soliciting, or receiving anything of value in exchange for referrals or services paid by federal healthcare programs
What does PHI stand for?
Protected Health Information
What is the basic purpose of OSHA?
To protect employees from injuries and illness in the workplace.
True or False: Privacy settings make it safe to post patient-related information online.
False!
What is waste?
Overuse of services or inefficient use of resources
What does “anything of value” include?
Money, gift cards, meals, entertainment, discounts, or free services
Give two examples of PHI.
Name the three categories of hazards OSHA focuses on.
Biological, Chemical and Physical Hazards.
Can you send patient information through direct messages or private chats?
No; only through CEENTA email, Teams, or Epic.
Practices inconsistent with accepted standards
What does Stark Law restrict?
Referrals of Medicare patients for certain services when there is a financial relationship with the entity providing those services
Where should you report Compliance issues of any type?
Your manager and Compliance (email and Healthicity).
Give one example of a bloodborne pathogen.
Hepatitis, HIV, etc.
True or False: Recording in clinical areas is allowed if it is for personal use.
False.
Give one example of fraud or abuse in healthcare.
Billing for services that did not occur, incorrect billing due to poor documentation practices
True or False: Accepting gift cards from vendors is acceptable if the amount is small.
False!
If you see PHI laying out, unattended, what should you do?
Bring it to your manager and report it. We also have shred bins you can put papers in.
What are the routes of exposure of a bloodborne pathogen?
Mouth, Eye, Ear, Needlestick, cut, etc.
Why is posting patient information on social media a violation, even if it seems anonymous?
Because it is shared on a third-party platform that CEENTA does not control and does not have a business associate agreement with
True or False: Ignoring known documentation errors can create compliance risk.
True.
True or False: Referrals should always be based on what is best for the patient, not financial relationships.
True.
True or False: You can report on Healthicity anonymously.
True: You can select your location, template, and then select I am reporting for "anonymous."
A chemical spill occurs, and you aren't sure how to clean it up. How can you check to confirm?
The safety data sheet.
What should you do if your device containing access to CEENTA systems is lost or stolen?
Report it to IT and Compliance immediately!