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Focus on Federal Compliance
Preventing Health Care Fraud and Abuse
Overview
The Office of the Inspector General (OIG) of the Department of Health and Human Services reported that approximately fourteen percent of health care claims were paid inappropriately due to fraud and abuse. That report focused on $23 billion in overpayments made in Medicare fee-for-service arrangements, with physicians accounting for 21.68 percent of these improper payments. For these reasons, the detection and elimination of health care fraud and abuse is a top priority of federal law enforcement.
Objectives
Upon completion of this course, a physician should be able to:
1. Explain why physicians and dentists need to develop a compliance plan.
2. Discuss the laws that cover health care compliance.
3. Identify criminal penalties that may be imposed on doctors who break compliance laws.
4. Know how health care fraud is detected.
5. Develop a compliance plan for the medical office.
Target Audience
This course is designed for physicians who want information on avoiding liability associated with erroneous or fraudulent billing practices.
Metholodogy
This is a self-study course consisting of text and CME test. Physicians should read the course content, answer the test questions and submit the answers for scoring. Those who complete the course with a score of 80 percent or higher will earn a maximum of 2 AMA PRA Category 1 creditsTM.
Faculty/Author
This course was developed by Rosemary Gafner, Ed.D. Dr. Gafner’s CV is available on request or online at https://www.medrisk.com/Medrisk/Faculty/CV/default.aspx.
CME Information
Medical Risk Management, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education for physicians. Medical Risk Management, Inc.designates this continuing medical education activity for a maximum of 2 AMA PRA Category 1 creditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This activity is valid for release May 1, 2007 and expires on April 30, 2010.
Commercial Support
This activity was developed solely by Medical Risk Management, Inc. without any outside commercial support.
 Please check with your insurance carrier for approved courses before registering. Courses not approved by your insurance carrier will not be accepted by them for any discounts they may offer.
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