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Health Care Compliance

Health Care Compliance. Lesson 2 Fraud and Abuse. Fraud and Abuse. Corporate compliance is often identified closely with the fight against fraud and abuse. But what is fraud? What is abuse?. Fraud. Intentional deception or misrepresentation Reckless disregard. 55 mph. Fraud.

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Health Care Compliance

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  1. Health Care Compliance Lesson 2 Fraud and Abuse

  2. Fraud and Abuse Corporate compliance is often identified closely with the fight against fraud and abuse. But what is fraud? What is abuse?

  3. Fraud • Intentionaldeception or misrepresentation • Reckless disregard 55 mph

  4. Fraud • Fraud includes • material false statements or representations uttered or made to obtain some benefit to which one is not entitled

  5. Common Types of Fraud • Services not rendered • Falsifying information on records • Intentional Up-coding • Kickbacks

  6. Abuse Not Intentional Civil

  7. Abuse • Erroneous coding • Improper dates of service • Cost reporting errors When can abuse become fraud?

  8. Laws and Regulations

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