Fighting Healthcare Fraud and Abuse: The Stakes and Consequences

Instructor: Michael Reynolds
Product ID: 703383
  • Duration: 90 Min

recorded version

1x Person - Unlimited viewing for 6 Months
(For multiple locations contact Customer Care)
Recorded Link and Ref. material will be available in My CO Section
Last Recorded Date: Feb-2016

Training CD / USB Drive

One CD/USB is for usage in one location only.
(For multiple locations contact Customer Care)
CD/USB and Ref. material will be shipped within 15 business days

Customer Care

Fax: +1-650-362-2367


Read Frequently Asked Questions

This webinar will explain the laws that regulate Fraud, Waste, and Abuse (FWA) including the Stark law. Attendees will learn how to detect, prevent and report healthcare fraud and abuse.

Why Should You Attend:

Health care fraud is an intentional misrepresentation, deception, or intentional act of deceit for the purpose of receiving greater reimbursement. Health care abuse is reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.

This webinar will help attendees to identify fraud early, root it out quickly, and protect patients from the harmful consequences of fraud. It will provide a powerful deterrent to would-be perpetrators looking to prey on patients and steal money from taxpayers.

Areas Covered in the Webinar:

  • Understand Fraud, Waste, and Abuse (FWA) training requirements
  • What laws regulate Fraud, Waste, and Abuse
  • Describe steps taken to prevent and combat FWA
  • Refer suspected FWA to your special investigations unit
  • Understand the federal Whistle Blowers Act
  • Understand STARK law
  • Fraud and abuse case studies
  • Increased law enforcement coordination in 2016
  • Medicare Part D enforcement
  • NPI compromise could lead to fraud charges
  • Whistleblower laws

Who Will Benefit:

This webinar will provide valuable assistance to all personnel in medical offices, practice groups, hospitals, academic medical centers, insurers, business associates (shredding, data storage, systems vendors, billing services, etc.). The titles are:

  • Compliance Director
  • CEO
  • CFO
  • Insurance Claim Auditors
  • Insurance Fraud Examiners
  • Privacy Officer
  • Security Officer
  • Information Systems Manager
  • HIPAA Officer
  • Chief Information Officer
  • Health Information Manager
  • Healthcare Counsel/Lawyer
  • Office Manager
  • Contracts Manager
  • Medical Coders
  • Medical Billers

Instructor Profile:

Michael A. Reynolds, CPC, CCP-P, CPMB, CBCS, OS, OS has over 26 years’ experience in the Health Care field with expertise in areas such as Health Care Management, Medical Billing and Collections, Medical Coding, Medical Reimbursement, Managed Care Claims Processing and Appeals, Customer Service Rep., Premium Service Rep., Health Care Compliance management, Medical Coding and Billing Instructor. Michael has served as the 2005, 2008 and 2011 President of the San Diego Chapter of the American Academy of Professional Coders, and is a current Board Member for National Health career Association. Michael is a current Member of the American Academy of Professional Coders, member of the Professional Medical Billers Association and the board of medical specialty coding. Michael currently teaches both medical billing and coding and electronic health records at San Diego state university and is part owner of Pitt & Reynolds Medical Coding and Consulting.

Topic Background:

Health care fraud and abuse is a national problem that affects each of us either directly or indirectly and affects both health care quality and safety. The financial losses to health care fraud nationwide are estimated to cost tens of billions of dollars a year, according to the National Health Care Anti-Fraud Association. These losses lead to increased health care costs and potential increased costs for coverage. Fraud and abuse also can result in serious harm to people who are subjected to unnecessary or inappropriate medical services – or to services by providers who are not licensed or qualified to provide them.

Types of Health Care Fraud and Abuse

Health care fraud and abuse takes many forms. The most common of these forms include:

  • Billing for services that were not provided
  • Duplicate submission of a claim for the same service
  • Misrepresenting the service provided
  • "Upcoding" - charging for a more complex or expensive service than was actually provided
  • Billing for a covered service when the service actually provided was not covered

Policy Holders
  • Using a member ID card that does not belong to that person
  • Adding someone to a policy that is not eligible for coverage (i.e., grandchildren)
  • Failing to remove someone from a policy when that person is no longer eligible (i.e., a former spouse)
  • "Doctor shopping" - visiting several doctors to obtain multiple prescriptions.
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Refund Policy

Registrants may cancel up to two working days prior to the course start date and will receive a letter of credit to be used towards a future course up to one year from date of issuance. ComplianceOnline would process/provide refund if the Live Webinar has been cancelled. The attendee could choose between the recorded version of the webinar or refund for any cancelled webinar. Refunds will not be given to participants who do not show up for the webinar. On-Demand Recordings can be requested in exchange.

Webinar may be cancelled due to lack of enrolment or unavoidable factors. Registrants will be notified 24hours in advance if a cancellation occurs. Substitutions can happen any time.

If you have any concern about the content of the webinar and not satisfied please contact us at below email or by call mentioning your feedback for resolution of the matter.

We respect feedback/opinions of our customers which enables us to improve our products and services. To contact us please email call +1-888-717-2436 (Toll Free).

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