Common types of healthcare fraud include: • Billing for no-show appointments • Submitting claims for services at a higher complexity and higher claim reimbursement levels than presented or documented • Billing for services not provided, and payments made for referrals Regulatory compliance obligations govern all agreements in the healthcare world. Such regulations include HIPAA, Stark I, II, III; False Claims, HITECH, Federal Anti-Kickback Statute, and JCAHO to name a few. Can implementing the healthcare obligation management and compliance solutions combat the risks of healthcare fraud?

1. REDUCING FRAUD RISK IN
HEALTHCARE PROVIDERS' CONTRACTS
Aavenir
with Automated Obligation Management

2. Table of Content
Healthcare Frauds Healthcare Compliance Program
Applicable Laws &
Regulations
Obligation Management for Fraud
Prevention
Common types of Healthcare fraud
detected across the US
Best practices & a well-designed
compliance program to combat fraud
Types of agreements and regulatory
compliance obligations
Ongoing obligation and compliance
management-powered by AI

3. TYPES OF
HEALTHCARE FRAUDS

4. Billing for services not rendered
Misrepresenting date, location, or
service provider
Incorrect reporting of diagnosis or
procedures
Corruption and kickbacks
False issuance of drugs prescription
Healthcare Frauds

5. LAWS & REGULATIONS IN THE
UNITED STATES HEALTHCARE

6. The Stark Law
Federal Anti-Kickback Law
False Claims Act
The Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
Health Insurance Portability and
Accountability Act (HIPAA)
The Health Information Technology for
Economic and Clinical Health (HITECH) Act
Healthcare Regulations

7. COMPLIANCE PROGRAM
HEALTHCARE

8. Speed up and optimize proper payment of
claims
Minimize billing and “creative” invoicing
mistakes
Reduce the chances of a HealthCare
Financing Administration (HCFA) or Office
of Inspector General (OIG) audit
Avoid conflicts with self-referral and anti-
kickback statutes
Compliance Practices

9. OBLIGATION MANAGEMENT
FOR FRAUD PREVENTION

10. Implement written policies, procedures, and
standards of conduct.
Designate Compliance Officer and a
compliance committee.
Conduct effective training & education
Identify, Track, Manage, & Monitor
obligations at each level
Obligation Management

11. AI-ENABLED
OBLIGATION & COMPLIANCE MANAGEMENT SOLUTION

12. helps you achieve
70% 35%
98% 71%
faster obligation identification cycle
time
cost savings with centralized
obligations fulfilment approach
on-time obligation fulfillment improvement in compliance

13. To learn more, FREE download
E-BOOK
E-BOOK
REDUCING HEALTHCARE
REDUCING HEALTHCARE
FRAUDS
FRAUDS
PRODUCT BRIEF
PRODUCT BRIEF
OBLIGATION MANAGEMENT
OBLIGATION MANAGEMENT
SOLUTION
SOLUTION