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Health Plan Compliance: Fraud, Waste and Abuse

Every year, millions of dollars are improperly spent because of fraud, waste and abuse. All health plans that pay claims for beneficiaries of government healthcare programs are required to complete compliance training as part of an effective compliance program. The consequences of committing fraud, waste or abuse include civil money penalties, criminal convictions and fines, civil prosecution, imprisonment, loss of provider license, and/or exclusion from Federal healthcare programs.

The HCCS Health Plan Compliance: Fraud, Waste and Abuse online training educates staff on how to prevent, detect, and correct fraud, waste and abuse.

Number of Learners:

Course Outline

  • Definitions of fraud, waste and abuse
  • Various government programs vulnerable to fraud, waste and abuse
  • What constitutes a violation of the False Claims Act
  • Fines, criminal charges and administrative sanctions under the False Claims Act
  • Existence of state False Claims Acts
  • False Claims Act provisions regarding whistleblowers / qui tam relators
  • Prohibition against employer retaliation against whistleblowers
  • Anti-Kickback Statute and penalties
  • Stark / Physician Self-Referral Law and penalties
  • Health plans and identity theft
  • Recognizing fraud, waste and abuse
  • Prescription fraud indicators and other potential fraud indicators

Target Audience

  • All health plan employees, contractors and vendors