Medicare and Medicaid Fraud and Abuse Prevention

Outline:
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. Medicare.gov/fraud C. Medicare Summary Notice (MSN) D. MyMedicare.gov 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

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.