Fraud, Waste & Abuse in Health Care
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What's the difference between fraud, waste and abuse when it comes to health care? What is the government doing to prevent fraud, waste and abuse from happening? Learn the definitions and differences in these legal terms and how CMS has worked to prevent these from happening since its inception in 1965.
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Fraud, Waste & Abuse in Health Care
- 1. Fraud, Waste & Abuse in Health Care
- 2. Definitions
- 3. Definitions Terms have legal significance
- 5. Definitions Fraud Action: Knowingly making a false statement or claim
- 6. Definitions Fraud Action: Knowingly making a false statement or claim Result: Funding unauthorized benefit
- 7. Definitions Fraud Example: Filing a claim on services that were never performed
- 9. Definitions Waste Action: Misuse or overuse of resources
- 10. Definitions Waste Action: Misuse or overuse of resources Result: Funding unnecessary costs
- 11. Definitions Waste Example: Writing high-cost prescriptions over less expensive generic prescriptions
- 13. Definitions Abuse Action: Improper use of info or documentation
- 14. Definitions Abuse Action: Improper use of info or documentation Result: Funding for personal gain without evidence of criminal intent
- 15. Definitions Abuse Example: 99215 E/M for one hour when the visit was actually only 15 minutes
- 16. How prevalent is fraud & abuse in U.S. health care?
- 17. In 2011, $98 billion was lost due to Medicare/Medicaid fraud & abuse
- 18. What is the government doing to prevent fraud & abuse?
- 19. Title XIX to SSA 1965
- 20. Anti-Fraud & Abuse Amendments Title XIX to SSA 1965 1977
- 21. False Claims Act Anti-Fraud & Abuse Amendments Title XIX to SSA 1965 1977 1986
- 22. HIPAA False Claims Act Anti-Fraud & Abuse Amendments Title XIX to SSA 1965 1977 1986 1996
- 23. HIPAA False Claims Act Anti-Fraud & Abuse Amendments Title XIX to SSA Deficit Reduction Act 1965 1977 1986 1996 2005
- 24. HIPAA Healthcare Fraud False Claims Act Prevention & Enforcement Action Team (HEAT) Anti-Fraud & Abuse Amendments Title XIX to SSA Deficit Reduction Act 1965 1977 1986 1996 2005 2009
- 25. Meaningful Use American Recovery & Reinvestment Act/ HITECH 2009
- 26. Affordable Care Act Meaningful Use American Recovery & Reinvestment Act/ HITECH 2009 2010
- 27. Affordable Care Act Meaningful Use American Recovery & Center for Program Reinvestment Integrity Act/ HITECH 2009 2010
- 28. Healthcare Reform OIG Releases Affordable Care Act Report on E/Ms & EHRs Meaningful Use American Recovery & Center for Program Reinvestment Integrity Act/ HITECH 2009 2010 2012
- 29. Want to learn more about fraud & abuse in health care? Visit successehs.com/archived-webinars to view the free, complete webinar + slides, “EHRs, RAC Audits & Coding – What Providers Need to Know”