Healthcare Fraud: What You Need to Know
Healthcare fraud is a crime. There are economic, financial, and legal impacts involved with fraudulent activity within the health system. Fraud has the potential to occur in any healthcare setting and it can be committed by anyone involved in the process, including clinicians, patients, or others. As a clinician, you are at the forefront for combatting fraud, and in a unique position to advocate for the patient. This course will help prepare you in recognizing and avoiding fraud within your own practice, as well as empower you in reporting suspicious activity.
The goal of this course is to equip clinicians with the knowledge of how to recognize, avoid, and report healthcare fraud.
Healthcare fraud is a crime. There are economic, financial, and legal impacts involved with fraudulent activity within the health system. Fraud has the potential to occur in any healthcare setting and it can be committed by anyone involved in the process, including clinicians, patients, or others. As a clinician, you are at the forefront for combatting fraud, and in a unique position to advocate for the patient. This course will help prepare you in recognizing and avoiding fraud within your own practice, as well as empower you in reporting suspicious activity. The goal of this course is to equip clinicians with the knowledge of how to recognize, avoid, and report healthcare fraud.
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Feature Flag Details: Default value: false Flag: courseListSearch | User: 400010936Accreditation Council for Continuing Medical Education
In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Relias LLC designates this enduring activity for a maximum of 1.00 AMA PRA category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
American Nurses Credentialing Center
In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Nurses will receive 1.00 Nursing Contact Hours after successfully completing this course.
Arkansas State Board of Nursing
Arkansas State Board Of Nursing Approved Continuing Education program (CEBroker Provider #50-290).
Nurses will receive 1.00 contact hours for participating in this course.
California Board of Registered Nursing
Provider approved by the California Board of Registered Nursing, CEP# 13791
Nurses will receive 1.00 contact hours for participating in this course.
Commission for Case Manager Certification
This program has been pre-approved by The Commission for Case Manager Certification to provide 1.0000 hours of continuing education credit to CCM® board certified case managers.
District of Columbia Board of Nursing
District of Columbia Board of Nursing Approved Continuing Education program (CEBroker Provider #50-290).
Nurses will receive 1.00 contact hours for participating in this course.
Florida Board of Medicine
Florida Board of Medicine (CEBroker Provider #50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™.
Florida Board of Nursing
Florida Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Georgia Board of Nursing
Georgia Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Kentucky Board of Nursing
Kentucky Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Louisiana State Board of Medical Examiners
Louisiana State Board of Medical Examiners (CEBroker Provider #: 50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™.
Michigan Board of Nursing
Michigan Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Mississippi Board of Nursing
Mississippi Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Mississippi State Board of Medical Licensure
Mississippi State Board of Medical Licensure (CEBroker Provider #: 50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™.
New Mexico Board of Nursing
New Mexico Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
New Mexico Medical Board
Physicians will receive 1.00 AMA PRA category 1 Credits™.
North Dakota Board of Nursing
North Dakota Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Ohio State Medical Board
State Medical Board of Ohio (CEBroker Provider #: 50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™.
South Carolina Board of Medical Examiners
South Carolina Board of Medical Examiners (CEBroker Provider #50-290)
South Carolina Board of Nursing
South Carolina Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Tennessee Board Of Medical Examiners
Tennessee Board of Medical Examiners (CEBroker Provider #50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™
West Virginia Board of Registered Nursing
West Virginia Board of Registered Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
Define healthcare fraud and the problems identified with fraud control.
Recall key federal laws that are used to investigate and prosecute healthcare fraud.
Identify the clinician’s role in recognizing, avoiding, and reporting healthcare fraud.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Defining Healthcare Fraud
What is Healthcare Fraud?
Terminology
How is Healthcare Fraud Committed?
Fraud Detection Initiatives
Laws Governing Healthcare Fraud
Section 3: Prosecution and Investigation for Violators
Anti-Kickback Statute
Physician Self-Referral Law
False Claims Act
Civil Monetary Penalties
Exclusion Statute
Section 4: Avoiding Healthcare Fraud
Telemedicine
Clinician’s Role
Section 5: Reporting
What is a Whistleblower?
Why Report?
How to Report?
Whistleblower Best Practices
Additional Resources
Section 6: Clinical Vignette
Case Study
Section 7: Conclusion
Course Summary
Course Contributors
Resources
References
Laura L. Morgan, MSN, RN, CCRP, NEA-BC, currently serves as the Clinical Education Specialist at Lincoln County Medical Center in Ruidoso, New Mexico. She plans, develops, implements, and evaluates educational programs for clinicians, using the most current research and clinical data, while fostering the implementation of evidence-based practice. Ms Morgan is an endorsed member of the Society of Clinical Research Associates, member of Sigma Theta Tau international honors Society of nursing, an instructor for Basic Life Support, Advance Cardiovascular Life support and a Board Certified Nurse Executive-Advanced from the American Nurses Credentialing Center.Instructor: Brandy Verton, BSN, RN, CNOR
Brandy is a certified perioperative nurse with a background in both scrub and circulator roles across a variety of surgical specialties. She earned her BSN with summa cum laude honors from Capella University and has served as a Surgical Services Clinical Educator and Periop 101 instructor. Her early clinical experience on a postoperative and medical-surgical overflow unit shaped her commitment to patient-centered care and team collaboration. Throughout her career, she has contributed to hospital committees and process improvement efforts focused on safety, education, and quality outcomes. Brandy is passionate about creating practical, real-world education that helps clinicians feel supported in their work, build confidence in their skills, and continue delivering safe, effective care.
The target audience for this course is: Care and Case Managers; Medical Assistants; Medical Providers; Nursing Personnel; in the following settings: Hospitals: Acute.
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 (https://www.relias.com/help) 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.
