This document provides an overview of Medicare fraud, waste and abuse (FWA) training requirements. It defines FWA, outlines laws related to FWA, describes best practices for prevention, and notes individual responsibilities. Key points include annual FWA training is required for Medicare Part C organizations, defining fraud, waste and abuse, explaining false claims and anti-kickback statutes, and emphasizing individual responsibility to report suspected FWA.
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.
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.
Introduction to US Privacy and Data Security Regulations and Requirements (Se...Financial Poise
The United States has no federal data security or privacy law covering all businesses or all U.S. citizens. Instead, federal agencies and individual states have created their own patchwork of laws and regulations which must be evaluated for their application to a business.
This webinar will help you navigate the overlapping and sometimes confusing system of laws and regulations which may impact your business, ranging from emerging state-level privacy legislation to the numerous data breach notification statutes to cybersecurity regulations with extraterritorial effect.
To view the accompanying webinar, go to: https://www.financialpoise.com/financial-poise-webinars/introduction-to-us-privacy-and-data-security-regulations-and-requirements-2021/
This is a slideshow explaining the importance of protecting patient privacy and confidentiality. This slideshow is for education and training purposes only.
HIPAA in 2023: Changes, Updates, and Best PracticesConference Panel
HIPAA 2023 Guidance and Compliance refers to the latest regulations and guidelines for protecting patient privacy in healthcare. Healthcare organizations need to stay current on the rules and guidelines related to privacy, security, and breach notification. This includes understanding the key changes to HIPAA regulations, ensuring compliance for covered entities and business associates, implementing best practices for maintaining HIPAA compliance, and addressing the impact of technology and innovation on healthcare privacy and security. Training, risk assessments, audits, and patient rights are also essential aspects of HIPAA compliance.
Register for the HIPAA 2023 Guidance and Compliance Webinar,
https://conferencepanel.com/conference/hipaa-2023-latest-guidance-and-compliance-focus
This slideshow provides a brief overview of the basics of HIPAA. Viewers receive a walkthrough of its' core fundamentals. This represents Part 1 of 3 in a series that educate primary care providers on achieving HIPAA compliance.
Are you aware of Medicare Fraud and Abuse?Jessica Parker
Most physicians strive to work ethically, provide high-quality medical care to their patients, and submit proper claims for payment. Trust is at the core of the physician-patient relationship. The Federal Government also places enormous trust in physicians. Medicare and other Federal health care programs rely on physicians’ medical judgment to treat patients with appropriate, medically necessary services.
Introduction to US Privacy and Data Security Regulations and Requirements (Se...Financial Poise
The United States has no federal data security or privacy law covering all businesses or all U.S. citizens. Instead, federal agencies and individual states have created their own patchwork of laws and regulations which must be evaluated for their application to a business.
This webinar will help you navigate the overlapping and sometimes confusing system of laws and regulations which may impact your business, ranging from emerging state-level privacy legislation to the numerous data breach notification statutes to cybersecurity regulations with extraterritorial effect.
To view the accompanying webinar, go to: https://www.financialpoise.com/financial-poise-webinars/introduction-to-us-privacy-and-data-security-regulations-and-requirements-2021/
This is a slideshow explaining the importance of protecting patient privacy and confidentiality. This slideshow is for education and training purposes only.
HIPAA in 2023: Changes, Updates, and Best PracticesConference Panel
HIPAA 2023 Guidance and Compliance refers to the latest regulations and guidelines for protecting patient privacy in healthcare. Healthcare organizations need to stay current on the rules and guidelines related to privacy, security, and breach notification. This includes understanding the key changes to HIPAA regulations, ensuring compliance for covered entities and business associates, implementing best practices for maintaining HIPAA compliance, and addressing the impact of technology and innovation on healthcare privacy and security. Training, risk assessments, audits, and patient rights are also essential aspects of HIPAA compliance.
Register for the HIPAA 2023 Guidance and Compliance Webinar,
https://conferencepanel.com/conference/hipaa-2023-latest-guidance-and-compliance-focus
This slideshow provides a brief overview of the basics of HIPAA. Viewers receive a walkthrough of its' core fundamentals. This represents Part 1 of 3 in a series that educate primary care providers on achieving HIPAA compliance.
Are you aware of Medicare Fraud and Abuse?Jessica Parker
Most physicians strive to work ethically, provide high-quality medical care to their patients, and submit proper claims for payment. Trust is at the core of the physician-patient relationship. The Federal Government also places enormous trust in physicians. Medicare and other Federal health care programs rely on physicians’ medical judgment to treat patients with appropriate, medically necessary services.
Long Term Care Litigation - Conference Materials Rachel Hamilton
Gain the competitive advantage in increasingly high-stakes long term care defense at ACI’s 3rd Annual Forum on Preventing and Defending Long Term Care Litigation, the only conference that brings together a supreme in-house presence on the faculty, the top defense firms, and experienced jurists from around the country. Designed for both networking and masters-level strategy sharing, this is the leading forum in which to learn winning strategies to comply with the dense thicket of laws and regulations facing the LTC industry, avoid costly litigation altogether and to mount a complete and formidable defense if forced to do so.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
How the Opioid Crisis and the SUPPORT Act Created a New Enforcement Reality: ...Epstein Becker Green
How the Opioid Crisis and the SUPPORT Act Created a New Enforcement Reality: Trends in Behavioral Health Webinar Series
Presented by
Richard W. Westling – Member, Epstein Becker Green
Katherine Bowles – Attorney, Nelson Hardiman
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
During 2018, the Department of Justice dedicated additional enforcement resources to address the opioid crisis. By adding criminal penalties targeted at kickbacks in the SUD provider space, the SUPPORT Act significantly enhanced the many tools already available to the DOJ. These efforts will also likely further embolden private payor review activities.
More info: https://www.ebglaw.com/events/how-the-opioid-crisis-and-the-support-act-created-a-new-enforcement-reality-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Unpacking the SUPPORT for Patients and Communities Act: Trends in Behavioral ...Epstein Becker Green
The SUPPORT Act takes sweeping aim at the opioid crisis, focusing on numerous aspects of opioid prevention, treatment, and recovery and expanding various types of coverage, use of telemedicine, and electronic prescribing, among other things.
This webinar will highlight important parts of the new law as it pertains to SUD treatment providers and how the law will potentially impact profitability and treatment offerings.
Presented by Harry Nelson – Founder & Managing Partner, Nelson Hardiman; Chairman, Behavioral Health Association of Providers - and Paul D. Gilbert – Member of the Firm, Epstein Becker Green.
Part of a "first Thursdays" webinar series hosted by Behavioral Health Association of Providers, Epstein Becker & Green, P.C., and Nelson Hardiman, LLP.
More info: https://www.ebglaw.com/events/unpacking-the-support-for-patients-and-communities-act-trends-in-behavioral-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
2022 Fraud, Waste, & Abuse Training
1. 1
Medicare Part C and Part D:
Fraud, Waste and Abuse Training
Windstone Health Services
2022
2. 2
Overview
The Centers for Medicare & Medicaid Services (CMS)
requires annual Fraud, Waste and Abuse (FWA)
training for organizations providing health services to
Part C Medicare Advantage (MA) enrollees. All training
must be completed annually.
All entities are required to complete the Attestation of
Training Completion.
Organizations must maintain internal training logs and
submit copies of the training logs along with required
attestations demonstrating that employees received
FWA training.
3. Why Do You Need Training?
Every year billions of dollars are improperly spent because of
Fraud, Waste, and Abuse (FWA). It affects everyone – including
you. This training helps you detect, correct, and prevent FWA.
You are part of the solution.
Combating FWA is everyone’s responsibility. As an individual who
provides health or administrative services for Medicare enrollees,
every action you take potentially affects Medicare enrollees, the
Medicare Program, or the Medicare Trust Fund.
3
4. 4
FWA requirements…
Organizations contracting directly or indirectly with
the federal government are obligated to:
Report fraud, waste and abuse;
Demonstrate their commitment to eliminating fraud,
waste and abuse; and
Implement internal policies and procedures to identify
and combat health care fraud.
5. 5
Best Practices for Preventing FWA
Develop the seven (7) core compliance program.
Ensure all employees are familiar and up-to-date with
laws, regulations, company policies/procedures and
compliance program
Monitor claims for accuracy – ensure coding reflects
services provided.
Monitor medical records – ensure documentation
supports services rendered.
Perform regular internal audits.
Maintain effective line of communication
6. 6
The SEVEN elements of a compliance
plan
An effective Compliance Plan includes 7 core
elements:
1. Written Policies, Procedures and Standards of
Conduct
2. Designation of a Compliance Officer, Compliance
Committee and High Level Oversight.
3. Effective Compliance Training and Education.
4. Internal Monitoring and Auditing to Identify
Compliance Risks.
7. 7
The SEVEN elements of a compliance
plan
5. Disciplinary Mechanisms.
6. Effective Lines of Communication.
7. Procedures and Systems for Prompt Response
to Detected Offenses and Corrective Action.
8. 8
Definitions
Fraud:
• an intentional act of deception, misrepresentation, or
concealment in order to gain something of value.
• occurs when an individual knows or should know that
something is false and makes a knowing deception
that could result in some unauthorized benefit to
him/herself or another person.
Waste:
• over utilization of services (not caused by criminally
negligent actions) and the misuses of resources.
9. 9
Definitions
Abuse:
• Excessive or improper use of services or actions that are
inconsistent with acceptable business or medical
practice.
• Refers to incidents that, although not fraudulent, may
directly or indirectly cause financial loss.
• Involves payment for items or services where there was
no intent to deceive or misrepresent, but the
outcome results in unnecessary costs.
10. 10
Definitions
Examples include:
Charging in excess for services or supplies
Billing for items or services that should not be
paid for by Medicare.
Billing for services that were never rendered
Billing for services at a higher rate than is
actually justified.
Falsifying information in order to justify
coverage.
.
11. 11
Definitions
Examples include:
Failing to provide medically necessary services.
Marketing schemes such as offering beneficiaries a
cash payment as an inducement to enroll in Part D.
Selecting or denying beneficiaries based on their
illness profile or other discriminating factors.
Writing prescriptions for drugs that are not medically
necessary.
12. 12
Relevant FWA Laws: False Claims Act
The False Claims Act:
Enacted in 1863 to fight procurement fraud in the
Civil War
Amended through the American Recovery and
Reinvestment Act of 2009 (ARRA) - expanded the
scope of liability and gave the government enhanced
investigative powers
Prohibits knowingly presenting a false claim for
payment or approval; or making or using a false
record or statement in support of a false claim.
13. 13
Relevant FWA Laws:
Anti-Kickback Statute
The Anti-Kickback Statute:
Makes it a criminal offense to knowingly and willfully
offer, pay, solicit, or receive any compensation to
induce or reward referrals of items or services
reimbursable by a federal health care program.
Remuneration includes anything of value, directly or
indirectly, overtly or covertly, in cash or in kind.
Up to five years in prison and fines of up to $25,000
for violations of the anti-kickback status
If the patient suffers bodily injury as a result of
a scheme, the prison sentence may be 20+
years.
14. 14
Relevant FWA Laws:
Beneficiary Inducement Statute
Beneficiary Inducement Statue prohibits certain
inducements to Medicare beneficiaries. i.e. waiving the
coinsurance and deductible amounts
Red Flag Rule (Identity Theft Protection)
requires creditors to implement programs to identify, detect
and respond to patterns, practices, or specific activities that
could indicate identify theft.
15. 15
Relevant FWA Laws: Physician Self-
Referral Prohibition Statute (Stark Law)
The Physician Self-Referral Prohibition Statute,
commonly referred to as the “Stark Law,” prohibits:
Prohibits physicians from referring Medicare patients
to an entity with which the physician or physician’s
immediate family member has a financial
relationship—unless an exception applies.
Up to a $15,000 fine for each service provided. Up to a
$100,000 fine for entering into an arrangement or
scheme.
16. 16
Possible Civil and Criminal Penalties
False Claims Act
For each false claim: Criminal fines up to $250,000
Imprisonment up to 20 years
If the government proves it suffered a loss, the
provider is liable for three times the loss.
17. Administrative Sanctions
Denial or revocation of Medicare
provider number application
Suspension of provider payments
Addition to the OIG / SAM Lists of
Excluded Individuals/Entities (LEIE)
License suspension or revocation
17
18. 18
Examples of Potential FWA: Beneficiary
Identity Theft
Doctor Shopping
Improper Coordination of Benefits
19. 19
Examples of Potential FWA: Prescriber
Illegal Payment Schemes
Script Mills
Theft of Prescriber’s Drug
Enforcement Agency (DEA) Number
or Prescription Pad
20. 20
Examples of Potential FWA:
Pharmaceutical Manufacturer
Illegal Off-label Promotion
Illegal Usage of Free Samples
Kickbacks, Inducements, Other Illegal
Payments
21. 21
Partnership for FWA Prevention
Centers for Medicare & Medicaid Services
Medicare beneficiaries
Medicare contractors
Physicians, suppliers, and other providers
Quality Improvement Organizations (QIOs)
State and federal law enforcement agencies such as:
Office of Inspector General (OIG) and System of Award Management
(SAM) of the Department of Health and Human Services (HHS)
Federal Bureau of Investigation (FBI)
Department of Justice (DOJ)
Prevention and detection of fraud,
waste and abuse requires the
involvement and collaboration between:
22. 22
Your Responsibilities
How can you prevent potential fraud, waste and
abuse?
Comply with all federal and state laws and regulations, and
company policies and procedures and the company’s
compliance program.
Report any potential FWA
Know compliance officer/maintain effective communication
Participate in training and education
Comply with Standards of Conduct/Code of Conduct
Cooperate with internal monitoring and auditing.
Maintain confidentiality of protected health information
(PHI)
23. 23
Reporting FWA
Everyone is requested to report suspected fraud, waste
or abuse.
You may report anonymously.
Retaliation is prohibited when you report a concern in
good faith.
Take action if you identify a problem.
Remember that you could be held responsible for claims
bearing your name, regardless of whether you submitted
the claim.
• Erin Woodmas, Compliance Officer: x 238
• Patricia Rothstein, QI/Compliance Spec.: x 300
• Leanne Poploff, QI/Compliance Spec.: x 213
24. Reporting FWA
24
WEBSITE:
1. Go to “windstonehealth.com”
2. Click on “Provider Resources”
3. “Submit a Compliance Question or Concern
REMINDER:
Feel free to contact Erin Woodmas (ext. 238) or
Patty Rothstein (ext. 300) or
Leanne Poploff (ext. 213) for HIPAA Privacy
Rules or
Any questions or concerns you may have.
25. 25
FWA Resources
Resource Link
Centers for Medicare and
Medicaid Services (CMS)
www.cms.hhs.gov
Fraud & Abuse General
Information
www.cms.gov/About-CMS/Components/
CPI/CPIReportingFraud.html
Federal Bureau of Investigation www.fbi.gov/
Medicare Learning Network
(MLN)
www.cms.hhs.gov/MLNGenInfo/
Office of Inspector General
Department of Health and
Human Services
www.oig.hhs.gov/
Physician Self Referral Law www.cms.hhs.gov/PhysicianSelfReferral
Medicare Managed Care
Manual
www.cms.hhs.gov/Manuals/IOM/
26. 26
Exclusion Lists
We do not contract with any providers who appear on
the Office of the Inspector General (OIG) or System of
Award Management (SAM) lists, and now included are
also CMS Preclusion List. (Per contract requests)
Human Resources checks the OIG and SAM
exclusions lists for all employees.
This is part of the new hire and credentialing process and
is conducted prior to hire/contracting and monitored on a
monthly basis.
27. 27
Compliance
Windstone ensures compliance with applicable
statues, regulations and guidance from:
The Federal Trade Commission
The United States Department of Justice, Anti Trust
Division
28. 28
Attestation of Training Completion
Congratulations!
You’ve completed the FWA training
requirement for calendar year 2022.