Healthcare Fraud: What You Need to Know
Hours: 1.00
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.
California Board of Registered Nursing
Provider approved by the California Board of Registered Nursing, CEP# 13791
Nurses will receive 1.0000 contact hours for participating in this course.
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 Nursing
Florida Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
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.
Georgia Board of Nursing
Georgia Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 1.00 contact hours for participating in this course.
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.
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.
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.
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.
Kentucky Board of Nursing
Kentucky 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.
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.
Accreditation 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.
Florida Board of Medicine
Florida Board of Medicine (CEBroker Provider #50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™.
Ohio State Medical Board
State Medical Board of Ohio (CEBroker Provider #: 50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™.
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™.
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 Medical Board
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)
Tennessee Board Of Medical Examiners
Tennessee Board of Medical Examiners (CEBroker Provider #50-290)
Physicians will receive 1.00 AMA PRA category 1 Credits™
American Association of Medical Assistants
This program has been granted prior approval by the American Association of Medical Assistants (AAMA) for 1.00 general continuing education unit(s) (approval Administrative, General). Granting approval in no way constitutes endorsement by the AAMA of the program content or the program provider.
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.
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 graduated summa cum laude with a Bachelor of Science in Nursing degree from Capella University. She is a certified perioperative nurse with versatile skillsets in the circulator and scrub roles for an array of surgical specialties. She fulfilled numerous nursing leadership responsibilities as the Surgical Services Clinical Educator and Periop 101 instructor for UNC REX Healthcare located in NC. She has been an active member of several hospital committees and contributed to numerous process improvement initiatives. She developed her core nursing skills early in her career while working on a postoperative and medical-surgical overflow unit where she served in a variety of roles, including charge nurse, preceptor, Magnet Champion, and admission/discharge facilitator. She currently works as a perioperative SME and course writer at Relias.
The target audience for this course is: Certified Medical Assistants; Nurses; Physicians; in the following settings: Acute Care Facility.
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.
