Fraud, Waste, and Abuse Microlearning

This brief yet comprehensive course covers fraud, waste, and abuse in healthcare. The featured scenarios highlight prevention, detection, and correction through a practical example that is based on an actual Medicare fraud scheme. Fraud, waste, and abuse are also defined and differentiated, and relevant laws are overviewed, including the Anti-Kickback Statute (AKS) and the federal civil False Claims Act (FCA). Finally, reporting procedures and resources are addressed as a vital personal responsibility toward the correction of fraud, waste, and abuse.

Course Objectives
1. Define and differentiate between the actions and outcomes of healthcare fraud, waste, and abuse
2. Become familiar with relevant laws related to healthcare fraud and abuse, including penalties for violation and the protection offered to whistleblowers
3. Understand when and how to report fraud, waste, or abuse both within your organization and to federal agencies

This module is designed to be a refresher course for annual retraining and/or for the initial training of experienced staff across healthcare settings. Along with its companion course, General Compliance Microlearning, it provides education to help Medicare Advantage organizations, Part D plan sponsors, and managed care organizations that contract with state Medicaid agencies to meet the following federal regulations related to training and the detection and prevention of fraud, waste, and abuse:

• 42 C.F.R. Section 422.503(b)(4)(vi)(C)(1)
• 42 C.F.R. Section 423.504(b)(4)(vi)(C)(1)
• 42 C.F.R. Section 438.608(a)(1)

Estimated Runtime: 8 minutes
Last Updated: August 31, 2023
Publication Year: 2023

Reviewed and approved by
Nancy Allen, BSN, RNC, CMC

NOTE: This course is not a substitute for legal advice for any individual provider or situation. Always consult your company’s legal or compliance personnel with any questions or concerns related to this subject matter.