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Fraud and Abuse
Compliance Education and Training
One Compliance Credit earned for viewing presentation and completing quiz
Physicians and Staff may earn one compliance credit by viewing this slide show, completing the assessment, and faxing the assessment to the
University Privacy and Contracting Office: 504-988-7777
This presentation may be viewed for compliance credit only once in a fiscal year
(July 1 - June 30).
To check how many compliance credits you have and to see which training sessions you have completed, contact the University Privacy and Contracting Office at
It is the policy of TUMG to provide healthcare services that are in compliance with all state and federal laws governing its operations and consistent with the highest standards of business and professional ethics. Education for all TUMG physicians is an essential step in ensuring the ongoing success of compliance efforts.
In recent years, billing and reimbursement for some services has greatly increased
The OIG Work Plan often targets those medical services where reimbursement exceeds budget projections
The Medicare Program is under increasing pressure to remain solvent as “baby boomers” move into Medicare-eligible age range.
The prescription benefit will add more cost to the program$$ EXPENSE $$
During 2004, the prosecutes billing fraud and abuse…Federal Government won or negotiated approximately $605 million in judgments and settlements.
U.S. Attorneys’ Offices opened 1,002 new criminal health care fraud investigations involving 1,685 potential defendants.
A total of 459 defendants were convicted for health care fraud-related crimes during the year.
The Department of Justice opened 868 new civil health care fraud investigations, and had 1,362 open civil health care fraud investigationsSome Sobering Facts: OIG 2004 Annual Report
Source: Annual Report of the Attorney General and the Secretary Detailing Expenditures and Revenues Under the Health Care Fraud and Abuse Control Program For Fiscal Year 2003
It is a federal crime to defraud prosecutes billing fraud and abuse…
the U.S. Government or any of
its programs and can result in
imprisonment, fine or both.
Source: OIG website http://oig.hhs.gov/fraud/enforcement/criminal/05/1205.html
Source: OIG website http://oig.hhs.gov/fraud/enforcement/criminal/06/0306.html
February 2006 – Virginia prosecution?
… a podiatrist was sentenced to one year and one day in prison for mail fraud. The podiatrist billed for procedures performed at a surgery center when, in fact, the services performed were routine, and performed in the office. The address of the surgery center was actually a mailbox rental business located next to his office. Through his billing scheme, the podiatrist was reimbursed for facility-related charges such as pre-op and post-op rooms.Recent Fraud Cases
Source: OIG website http://oig.hhs.gov/fraud/enforcement/criminal/06/0206.html
End of Presentation prosecution?
To Earn Compliance Credit:
Complete and Sign the “Fraud and Abuse” Coding Quiz
Fax to: 504-988-7777