2012 Compliance: Fraud, Waste and Abuse (training - Ubhonline.com

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Pertinent Laws and Regulations • False Claims Act, cont. Examples include: • A physician who submits a bill to Medicare for medical services not provided. • A government contractor who submits records that he knows (or should know) are false and that indicate compliance with certain contractual or regulatory requirements. • An agent who submits a forged or falsified enrollment application to receive compensation from a Medicare Plan Sponsor. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 24
Pertinent Laws and Regulations • Anti-Kickback Statute – The Anti-Kickback law makes it a crime for individuals or entities to knowingly and willfully offer, pay, solicit, or receive something of value to induce or reward referrals of business under Federal health care programs. – The Anti-Kickback law is intended to ensure that referrals for health care services are based on medical need and not based on financial or other types of incentives to individuals or groups. – The Patient Protection and Affordable Care Act of 2010 (PPACA) or Health Care Reform Law has added a provision to the Anti-Kickback Statute where “knowingly and willfully” does not mean the individual had the intent to specifically violate the statute. In addition, violations of the Anti-Kickback statute can now be considered a false and fraudulent claim under the False Claims Act. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 25
Page 1 and 2: 2012 Compliance Fraud, Waste and Ab
Page 3 and 4: Overview, cont. • In regulations
Page 5 and 6: Overview, cont. • If you or your
Page 7 and 8: Compliance Expectations
Page 9 and 10: CMS Role and Definition • The Cen
Page 11 and 12: Seven Elements of an Effective Comp
Page 13 and 14: Effective Lines of Communication
Page 15 and 16: Exclusion and Debarment Review Requ
Page 17 and 18: CMS MLN FWA Training Materials
Page 19 and 20: Optum FWA Training Materials
Page 21 and 22: Fraud, Waste, and Abuse Policies
Page 23: Pertinent Laws and Regulations •
Page 27 and 28: Pertinent Laws and Regulations •
Page 29 and 30: Pertinent Laws and Regulations •
Page 31 and 32: Examples of Fraud, Waste, and Abuse
Page 33 and 34: Examples of Fraud, Waste, and Abuse
Page 35 and 36: Additional Resources • CMS’ Pre
Page 37 and 38: ANSWERS - Quiz and Self Assessment
Page 39: Documentation Requirements Attentio

2012 Compliance: Fraud, Waste and Abuse (training - Ubhonline.com

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