Medicare Parts C and D: General Compliance

Outline:
Section 1: Introduction

About This Course

Learning Objectives

Section 2: Traditional Medicare

Overview

Medicare Part A

Medicare Part B

Non-U.S. Citizenship Medicare Eligibility

Section 3: Medicare Part C

Overview

Medicare Part C FAQs

Medicare Part C and ESRD

Enrollment

Medicare Part C Type of Plans

Medigap

Knowledge Check Point

Section Key Takeaways

Section 4: Medicare Part D

Overview

Enrollment

Donut Hole

Knowledge Check Point

Section Key Takeaways

Section 5: General Compliance

Overview

Medicare Compliance Programs

Ethics

Code of Conduct

Knowledge Check Point

Section Key Takeaways

Section 6: Non-Compliance

Overview

Consequences of Non-Compliance

Reporting Non-Compliance

Post-Reporting and Corrections

Section 7: FWA and Relevant Laws

Overview

Fraud

Waste

Abuse

Reporting FWA

Civil False Claims Act (FCA)

Civil Monetary Penalties (CMP) Law

Health Insurance Portability and Accountability Act (HIPAA)

Knowledge Check Point

Section Key Takeaways

Section 8: Clinical Vignette

Section 9: Conclusion

Course Summary

Course Contributors

Resources

References

Shalla is a subject matter expert (SME)/writer for Relias. She completed her BSN and two undergraduate degrees with top honors from the University of Wisconsin-Madison. Shalla earned her dual MSN degrees from Johns Hopkins University with top honors. She also maintains her post-baccalaureate nurse educator certificate (NE-BC). Shalla’s tenure spans over 20 years of cross-functional leadership and direct clinical roles in healthcare, biopharma/biotech, government affairs, managed care/market access, nonprofit patient advocacy, and research. Her subject matter expertise is in rare, orphan, and complex diseases. Her sub-expertise is in immune-mediated diseases (rheumatology and immunology), genetics, neurology, hematology/oncology, several pediatric diseases, population/public health, and larger systemic healthcare affairs. Shalla is a published author with leading rare disease experts and a global speaker. She also sits on scientific, advocacy, and legislative advisory boards. She has led national advocacy and disease awareness campaigns, including speaking before congress, leading to the first-in-class rare disease biologic approval and investigative treatment protocols. 

Elizabeth Vaccaro earned her Bachelor of Science in nursing from Kean University. She has worked as a Multiple Sclerosis Nurse Educator. Elizabeth has worked in a variety of healthcare settings from the hospital to the pharmaceutical industry which has allowed her to have a great appreciation for all the challenges that span the healthcare field.  She has practiced in the hospice setting for nine years in a variety of roles from Case Manager, Educator, and Director of both inpatient and home care hospice.