Medicare and Medicaid Fraud and Abuse Prevention

Medicare and Medicaid Fraud and Abuse Prevention 

Welcome to the Medicare and Medicaid Fraud and Abuse Prevention learning module, presented by Relias! The sections in this module explain Medicare and Medicaid fraud and abuse prevention, detection, recovery, and reporting. The materials are designed for information givers/trainers who are familiar with the Medicare program and would like to have prepared information for their presentations.


Hours: 2.00


Certificates provided by accrediting body (0 Match)

Course Details

Course Code: REL-PI-0-P46
Hours: 2
Type: Online Course
Content Expiration Date: 2/28/2022
Learning Objectives:
Define fraud and abuse.
Identify causes of improper payments.
Discuss how CMS fights fraud and abuse.
Explain how you can fight fraud and abuse.
Recognize sources of additional information.

Section 1: Introduction A. About this Course B. Learning Objectives Section 2: Fraud and Abuse Overview A. Definitions of Fraud and Abuse B. Protecting Taxpayer Dollars C. Examples of Fraud D. Consequences of Sharing a Medicaid Card or Number E. Who Commits Fraud? F. Improper Payment Transparency- Medicare G. Improper Payment Transparency- Medicaid H. Causes of Improper Payments I. Preventing Fraud in Medicare Part C and Part D J. Telemarketing and Fraud- Durable Medical Equipment (DME) K. Quality of Care Concerns L. Review M. Summary Section 3: CMS Fraud and Abuse Strategies A. The Center for Program Integrity B. Program Integrity Contractors C. Zone Program Integrity Contractors (ZPICs) D. Zone Program Integrity Contractors (ZPICs) (Cont'd) E. Zone Program Integrity Contractors (ZPICs) Map F. Recovery Audit Program G. National Benefit Integrity Medicare Drug Integrity Contractor (NBI MEDIC) H. Outreach and Education (O&E MEDIC) I. Medicaid Integrity Contractors (MICs) J. CMS Administrative Actions K. Law Enforcement Actions L. Health Care Fraud Prevention Partnership M. Health Care Fraud Prevention and Enforcement Action Team (HEAT) N. Medicare Fraud Strike Force Teams O. Provider and Beneficiary Education P. Review Q. Summary Section 4: How You Can Fight Fraud A. "4Rs" for Fighting Medicare Fraud B. C. Medicare Summary Notice (MSN) D. E. 1-800-Medicare (TTY 1-877-486-2048) F. Learning Activity G. Learning Activity: What Might Indicate Fraud? H. Fighting Fraud Can Pay I. The Senior Medicare Patrol (SMP) J. Protecting Personal Information K. Identity Theft L. Reporting Suspected Medicaid Fraud M. Review N. Summary Section 5: Conclusion A. Summary B. Key Points to Remember C. Acronyms D. Course Contributors E. Resources F. References G. Congratulations

Instructor: Centers for Medicare & Medicaid Services National Training Program
The core components of this training module were developed and approved by the Centers for Medicare & Medicaid Services National Training Program (NTP). The original CMS content was enhanced with the addition of interactive vignettes, brought to you by Relias Learning. Disclosure: Centers for Medicare & Medicaid Services National Training Program has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.