Limiting Fraud and Abuse

Creating Better Cultures in Care Coordination

Healthcare fraud, abuse and waste is a national problem that can be found in every sector of the healthcare system. Fraud and abuse are not the only causes of wasteful spending, but they are major contributors. According to estimates from National Health Care Anti-Fraud Association (NHCAA), as much as 10 percent of all healthcare expenditures in the United States may be lost each year to fraud, abuse and waste. That is more than $100 billion annually—coming largely from healthcare providers and healthcare organizations attempting to defraud the system.

Health reform is strengthening the government’s capacity to fight fraud, waste and abuse in federal and state programs.

Join the publisher of Case In Point, Case In Point Weekly and the Case Management Resource Guide for a 90-minute online training session to learn how each healthcare professional can limit fraud, abuse and wasteful spending.

Continuing education credits have been applied for nurses, case managers, disability management specialists, psychologists, licensed mental health counselors, licensed marriage and family therapists, substance abuse counselors, and social workers. (See more below.)

About the Webinar

Healthcare fraud is defined as the intentional act of deceiving, concealing, or misrepresenting information that results in healthcare benefits being paid to an individual or group. Physicians, nurses, case/care managers, social workers and other members of the care coordination team who work for payers as well as providers can all be involved in addressing healthcare fraud. Successful efforts to stop such abuses, without unduly burdening legitimate providers, require aggressive, innovative, and sustained attention to protect all stakeholders. 

The recently passed Patient Protection and Affordable Care Act contains a number of provisions to strengthen the government’s capacity to fight fraud, waste and abuse in federal and state health programs. In addition, there is also a new department within the Centers for Medicare and Medicaid—the Center for Program Integrity—which is the single place where antifraud activities of Medicare and Medicaid will be coordinated. Peter Budetti, Deputy Administrator and Director for the Center for Program Integrity, said that the Center’s emphasis "will be on targeting interventions to the different causes of improper payments and moving to prevent them from occurring in the first place, rather than remaining in a pay-and-chase mode."

Healthcare professionals have a responsibility to be up to date on their role in combating fraud, abuse and waste as they coordinate care for their patients. To raise awareness and address the problem, payer and provider organizations are adopting internal controls that promote ways to prevent, detect and respond when fraud, waste and abuse is suspected or identified. Internal corporate compliance programs that track federal and state laws are responsible to ensure organizational compliance. In addition, they would be part of the team to address issues related to suspected fraud and abuse. 

The Case In Point Webinar series convenes an expert panel with a wide breadth of experience in healthcare law, risk management and regulatory compliance. Each will share their expertise and provide information that healthcare professionals can use to understand their role in limiting fraud, abuse and waste while creating better cultures in care coordination.

Program Objectives

The goal of this program is to enhance the ability of members of the care coordination teams to recognize, avoid and control healthcare fraud. After studying the information presented, you will be able to:

• Describe healthcare fraud and impact on the healthcare system in terms of cost and reputation.
• Identify the key federal laws governing health care fraud, abuse and waste.
• Describe the healthcare professional’s role in identifying, reporting and controlling healthcare fraud, abuse and waste.
• Identify whom to report if fraud, abuse and waste is suspected in your organization.

Our Webinar Will Answer These Questions:

• What is healthcare fraud and abuse?
• What is the cost of fraud, abuse and waste?
• Who is impacted by healthcare fraud and abuse?
• What is the responsibility of organizations to identify fraud and abuse?
• What are organizations doing to prevent fraud and abuse?
• What is the responsibility of the individual healthcare professional regarding fraud and abuse?
• How would a healthcare professional be involved in fraud and abuse?
• What do health care professionals need to do if they suspect fraud and abuse?
• What are the penalties for professionals and their organizations if fraud and abuse is found?
• What can healthcare professionals do who coordinate care for patients to educate them about fraud and abuse?
• What are some of the resources organization can access if they want more information on this topic?

Speakers:

	Jon Porter, JD Partner, McDonald, Mackay & Weitz, L.L.P.
	Susan Kohler, RN, BSN, MSML Vice President of Compliance and Regulatory Affairs, CeltiCare Health Plan
	Cindy Shifflett, BSN, CHC, CHRC, CPHRM, FASHRM Compliance Officer and HIPAA Privacy Officer, Spartanburg Regional Healthcare System
	Moderator: Anne Llewellyn RN-BC, MS, BHSA, CCM, CRRN Editor in Chief, Case Management Products Dorland Health, a Division of Access Intelligence

Who Should Attend

• Chief Financial Officers
• Chief Operating Officers
• Clinical Nurses
• Case/Care Managers
• Coders
• Compliance Officers
• Documentation Specialists
• Hospitalists
• Medical Directors
• Medical Management Directors and Supervisors
• Office Nurses
• Physicians (in all specialties)
• Physician Assistants
• Nurse Practitioners
• Risk Managers
• Utilization Review Personnel
• Quality Management ProfessionalsSafety Officers
• Social Workers