Your SlideShare is downloading. ×
0
Fraud, Waste & Abuse    in Health Care
Definitions
DefinitionsTerms have legal  significance
Definitions  Fraud
Definitions         FraudAction: Knowingly making a false statement or claim
Definitions          FraudAction: Knowingly making a false statement or claimResult: Funding unauthorized           benefit
Definitions         FraudExample: Filing a claim on   services that were    never performed
Definitions  Waste
Definitions          WasteAction: Misuse or overuse of         resources
Definitions          WasteAction: Misuse or overuse of         resourcesResult: Funding unnecessary           costs
Definitions         WasteExample: Writing high-cost  prescriptions over less    expensive generic      prescriptions
Definitions  Abuse
Definitions          AbuseAction: Improper use of info     or documentation
Definitions          AbuseAction: Improper use of info     or documentationResult: Funding for personal gain without evide...
Definitions         AbuseExample: 99215 E/M for one  hour when the visit was  actually only 15 minutes
How prevalent isfraud & abuse inU.S. health care?
In 2011, $98 billion  was lost due toMedicare/Medicaid   fraud & abuse
What is thegovernment doing   to prevent fraud & abuse?
Title XIX to SSA1965
Anti-Fraud & Abuse AmendmentsTitle XIX to SSA1965    1977
False Claims Act   Anti-Fraud & Abuse AmendmentsTitle XIX to SSA1965    1977       1986
HIPAA           False Claims Act   Anti-Fraud & Abuse AmendmentsTitle XIX to SSA1965    1977       1986   1996
HIPAA           False Claims Act   Anti-Fraud & Abuse AmendmentsTitle XIX to SSA                 Deficit Reduction Act1965...
HIPAA                                      Healthcare Fraud           False Claims Act       Prevention & Enforcement     ...
Meaningful Use  American Recovery &Reinvestment Act/ HITECH2009
Affordable Care ActMeaningful Use  American Recovery &Reinvestment Act/ HITECH2009             2010
Affordable Care ActMeaningful Use  American Recovery &             Center for ProgramReinvestment                 Integrit...
Healthcare Reform                                    OIG Releases           Affordable Care Act     Report on E/Ms        ...
Want to learn more aboutfraud & abuse in health care?Visit successehs.com/archived-webinars to view the free, complete web...
Fraud, Waste & Abuse in Health Care
Fraud, Waste & Abuse in Health Care
Upcoming SlideShare
Loading in...5
×

Fraud, Waste & Abuse in Health Care

2,039

Published on

What's the difference between fraud, waste and abuse when it comes to health care? What is the government doing to prevent fraud, waste and abuse from happening? Learn the definitions and differences in these legal terms and how CMS has worked to prevent these from happening since its inception in 1965.

Published in: Devices & Hardware
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
2,039
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
19
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Fraud, Waste & Abuse in Health Care"

  1. 1. Fraud, Waste & Abuse in Health Care
  2. 2. Definitions
  3. 3. DefinitionsTerms have legal significance
  4. 4. Definitions Fraud
  5. 5. Definitions FraudAction: Knowingly making a false statement or claim
  6. 6. Definitions FraudAction: Knowingly making a false statement or claimResult: Funding unauthorized benefit
  7. 7. Definitions FraudExample: Filing a claim on services that were never performed
  8. 8. Definitions Waste
  9. 9. Definitions WasteAction: Misuse or overuse of resources
  10. 10. Definitions WasteAction: Misuse or overuse of resourcesResult: Funding unnecessary costs
  11. 11. Definitions WasteExample: Writing high-cost prescriptions over less expensive generic prescriptions
  12. 12. Definitions Abuse
  13. 13. Definitions AbuseAction: Improper use of info or documentation
  14. 14. Definitions AbuseAction: Improper use of info or documentationResult: Funding for personal gain without evidence of criminal intent
  15. 15. Definitions AbuseExample: 99215 E/M for one hour when the visit was actually only 15 minutes
  16. 16. How prevalent isfraud & abuse inU.S. health care?
  17. 17. In 2011, $98 billion was lost due toMedicare/Medicaid fraud & abuse
  18. 18. What is thegovernment doing to prevent fraud & abuse?
  19. 19. Title XIX to SSA1965
  20. 20. Anti-Fraud & Abuse AmendmentsTitle XIX to SSA1965 1977
  21. 21. False Claims Act Anti-Fraud & Abuse AmendmentsTitle XIX to SSA1965 1977 1986
  22. 22. HIPAA False Claims Act Anti-Fraud & Abuse AmendmentsTitle XIX to SSA1965 1977 1986 1996
  23. 23. HIPAA False Claims Act Anti-Fraud & Abuse AmendmentsTitle XIX to SSA Deficit Reduction Act1965 1977 1986 1996 2005
  24. 24. HIPAA Healthcare Fraud False Claims Act Prevention & Enforcement Action Team (HEAT) Anti-Fraud & Abuse AmendmentsTitle XIX to SSA Deficit Reduction Act1965 1977 1986 1996 2005 2009
  25. 25. Meaningful Use American Recovery &Reinvestment Act/ HITECH2009
  26. 26. Affordable Care ActMeaningful Use American Recovery &Reinvestment Act/ HITECH2009 2010
  27. 27. Affordable Care ActMeaningful Use American Recovery & Center for ProgramReinvestment Integrity Act/ HITECH2009 2010
  28. 28. Healthcare Reform OIG Releases Affordable Care Act Report on E/Ms & EHRsMeaningful Use American Recovery & Center for ProgramReinvestment Integrity Act/ HITECH2009 2010 2012
  29. 29. Want to learn more aboutfraud & abuse in health care?Visit successehs.com/archived-webinars to view the free, complete webinar + slides, “EHRs, RAC Audits & Coding – What Providers Need to Know”
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×