Fraud, Waste & Abuse Prevention for Florida Healthcare Providers and Staff
Tracking # 20-1406817
Category:
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Program Objectives:
- Differentiate Fraud, Waste, Abuse, and Related Terms: Distinguish fraud, the False Claims Act civil knowledge standard, waste, abuse, error, improper payment, and overpayment.
- Recognize Common FWA Warning Signs: Identify claim, coding, documentation, medical-necessity, identity, credentialing, pharmacy, remuneration, exclusion, and telehealth warning signs.
- Explain Why Errors Are Not Automatically Fraud: Understand why a documentation defect, nonpayable claim, or overpayment is not automatically considered fraud.
- Identify Facts That Must Match Across Records and Claims: Verify consistency among the patient, record, rendering provider, date, location, diagnosis, medical necessity, service, and claim.
- Distinguish Major Federal and Florida Fraud Laws: Differentiate the Anti-Kickback Statute, Stark Law, beneficiary-inducement rules, Florida kickback law, and Florida’s Patient Brokering Act at an operational level.
- Explain Federal Exclusions and Database Matches: Describe the effect of federal exclusions and respond appropriately to a possible database match.
- Apply Florida Medicaid Provider Duties: Follow Florida Medicaid documentation, record-access, payment-in-full, enrollment, and medical-necessity requirements.
- Choose an Authorized Reporting Route: Report concerns through the appropriate channel and provide useful facts without conducting an independent investigation.
- Distinguish Anonymous and Confidential Reporting: Explain reporting options and describe non-retaliation protections without overpromising.
- Describe Overpayment Response Steps: Explain the report, return, written-explanation, correction, and monitoring steps required after an overpayment is identified.
- Distinguish Roles and Responsibilities: Differentiate the responsibilities of individuals, practitioners, provider organizations, health plans, and government agencies.
- Apply Plan-Specific Requirements: Locate and apply a plan-specific reporting or operational requirement without confusing it with general law.
Course Overview:
This two-contact-hour, self-paced course prepares healthcare professionals, clinical and nonclinical staff, contractors, vendors, coders, billers, managers, compliance personnel, and provider organizations to recognize and respond to fraud, waste, abuse, error, improper payment, and overpayment risks. Modules 1-9 provide a payer-neutral federal and Florida core. Module 10 addresses verified health-plan-specific requirements and reporting procedures.
$8.00
2 Hours