Medicare Fraud and Abuse

Course Code: REL-PAY-0-MFA

Hours: 1

Type: Online Course

Content Expiration Date: 12/31/2026

Learning Objectives:
Define Medicare fraud and abuse.
Recognize the societal impact of Medicare fraud and abuse.
Recognize how to prevent Medicare fraud and abuse.

Outline:
Section 1: Introduction

About This Course

Learning Objectives

Section 2: Overview of Fraud and Abuse

What Is Medicare?

What Is Medicare Fraud?

What Is Medicare Abuse?

What Is Medicare Waste?

Improper Payments

Review

Summary

Section 3: Societal Impact

Fraud and Abuse Perpetrators

Medicare Fraud and Abuse Laws

False Claims Act (FCA)

Anti-Kickback Statute (AKS)

Physician Self-Referral Law (Stark Law)

Social Security Act

The United States Criminal Code for Health Care Fraud

Clinical Impact of Fraud and Abuse

Medicare Marketing Rules

Review

Summary

Section 4: Anti-Fraud and Abuse Partnerships

Medicare Anti-Fraud and Abuse Partnerships

Office of the Inspector General (OIG)

Health Care Fraud Prevention and Enforcement Action Team (HEAT)

Medicare Fraud Strike Force

General Services Administration (GSA)

Review

Summary

Section 5: Fight Against Medicare Fraud

Overview

Record

Review

Report

Remember

Fraud Prevention Tips

Summary

Section 6: Clinical Vignette

Case Study

Section 7: Conclusion

Course Summary

Course Contributors

Resources

References

Subject Matter Expert: Judy Campbell, MSN, RN, CCM

Judy Campbell, MSN, RN, CCM has been a registered nurse since 2008. She is a subject matter expert in care coordination, which occurs at the intersection of patients, providers, and healthcare settings. As a certified case manager, her aim is to assist in transforming fragmented health systems to become coherent and manageable. To continue to cultivate her growth and entrepreneurial spirit, Judy is also a freelance writer that provides high-quality content for healthcare professionals.

Writer: Kimberly Workman, MA

Ms. Workman is an Instructional Designer at Relias. She has a Master of Arts in Technology and Communication, as well as graduate certificates in Public Health, Epidemiology, and Digital Communications. Ms. Workman has a background in writing and designing online continuing medical education for physicians and other health professionals on multiple educational platforms, including web-based, game-based, and immersive learning environments. She has also used simulation training extensively to connect learning to real-world environments.

Target Audience:
The target audience for this course is: General Staff; in the following settings: Acute Care Facility.

Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.

Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.

Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.