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Health Care Fraud/Abuse & Compliance   Presented by: Daniel J. Osborne, M.S.
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Health Care  Fraud & Abuse
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Health Care Fraud/Abuse - Examples ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Health Care Fraud/Abuse - Examples ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Health Care Fraud/Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Health Care Fraud/Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Practice Time Bombs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Top Ten Reasons for Visit from the Fraud Squad ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigators Guide to Evaluating Health Care Records ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fraud Prosecution  – Burden of Proof ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laws & Rules
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Administrative Laws ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Third-party payers ,[object Object],[object Object],[object Object],[object Object]
Did you know? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medicare -  Background ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CMS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Financial Hardships ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Federal Laws & Statutes -  Civil ,[object Object],[object Object],[object Object],[object Object],[object Object]
Federal Laws & Statutes -  Criminal ,[object Object],[object Object],[object Object],[object Object],[object Object]
Federal Laws & Statutes -  Criminal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
State Laws ,[object Object],[object Object],[object Object]
Documentation
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Documentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Documentation Musts ,[object Object],[object Object],[object Object],[object Object],[object Object]
Coding
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
CPT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CPT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CPT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Compliance
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Test your knowledge ,[object Object],[object Object]
Benefits of Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is health care compliance? ,[object Object],[object Object]
Standards for Compliance ,[object Object]
Standard One Compliance Standards & Procedures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Standard Two Overall  Program Oversight ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Standard Three Due Care Delegating Authority ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Standard Four Employee Education & Training ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Standard Five Monitoring, Auditing & Reporting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Standard Six Consistent Enforcement/Discipline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Standard Seven Response & Corrective Action ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Got R’ Done

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