This webinar will discuss the various anti-fraud and abuse provisions of the Affordable Care Act and will discuss the actions of that should be taken to minimize enforcement activities. Medicare it is a higher risk Federal program and has been designated as such by the GEN accountability office since 1990. Its vast size and complexity make it vulnerable to fraud, waste and abuse.
Lewis Morris, chief counsel to the Office of Inspector General, Department Of Health and Human Services, testifying before the Senate Finance Committee in 2009, stated, "Although we cannot measure the full extent of the health care fraud in Medicare and Medicaid, everywhere we look we continue to find fraud in these programs." Conservative estimates indicate that as much as $60 billion of total national health care spending is fraudulent.
According to the New England Journal of Medicine, federal investigators have found that the Medicare System is being infiltrated by criminals and organized crime. However, fraud is not limited to the activities of organized crime.
In Morris's testimony, he indicated, "Major corporations such as pharmaceutical and medical device manufacturers and institutions such as hospitals and nursing facilities have also committed fraud, sometimes on a grand scale."
The Obama Administration has created a cabinet-level anti-fraud task force, overseen by the deputy attorney general and the deputy HHS' secretary. This task force will oversee "strike force teams," composed of investigators from various federal agencies. The initial teams will be doubled and will target cities where healthcare fraud is rampant.
Obamacare includes sweeping provisions to combat healthcare fraud and abuse. You should attend this webinar to learn about these provisions and how you can protect yourself and your organization.
Areas Covered in the Session:
- More money to prevent and fight fraud
- Hiring new agents and investigators
- New task force
- Better screening and compliance activities
- Pre-enrolment screening program
- Oversight of providers and suppliers
- Moratorium to prevent new providers from joining program
- Withholding payment where credible allegation of fraud made
- New controls on high risk programs
- Expand RAC program
- Expand security bond program
- Compliance programs required
- Limits time for filing claims
- New fines and penalties
- Stronger civil and monetary penalties
- Increase in sentencing guidelines for healthcare fraud
- New fines and penalties for failure to return overpayments
- Recapture fraudulent funds
- New penalties for false claims
- New penalties for marketing violations
- Increased investigative power for nursing home fraud
- Greater data sharing
- Centralizes claims data
- New data bank
- Centralized data bank to identify "false front" providers
- DOJ and OIG has greater access to CMS claims and payment data
- Requires states to report additional Medicaid data
- Requires faster sharing of terminated provider data with states
Who Will Benefit:
- Actions that should be taken
- Chief Executive Officers
- Chief Operating Officers
- Corporate Compliance Officers
- Hospital Corporate Counsel
- Chief Financial Officers
- Physician Practice Managers
Upon completion of this activity, participants will be able to:
CME Credit Statement
- Discuss the various anti-fraud provisions of the Affordable Care Act and the actions that should be taken to minimize enforcement activities.
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of CFMC and MentorHealth. CFMC is accredited by the ACCME to provide continuing medical education for physicians.
CFMC designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Other Healthcare Professionals Credit Statement
This educational activity has been planned and implemented following the administrative and educational design criteria required for certification of health care professions continuing education credits. Registrants attending this activity may submit their certificate along with a copy of the course content to their professional organizations or state licensing agencies for recognition for 1 hour.
It is the policy of CFMC and MentorHealth that the faculty discloses real or apparent conflicts of interest relating to the topics of the educational activity.
All members of the faculty and planning team have nothing to disclose nor do they have any vested interests or affiliations
Obtaining Certificate of Credit
Colorado Foundation for Medical Care (CFMC) hosts an online activity evaluation system, certificate and outcomes measurement process. Following the activity, you must link to CFMC's online site (link below) to complete the evaluation form in order to receive your certificate of credit. Once the evaluation form is complete and submitted, you will be automatically sent a copy of your certificate via email. Please note, participants must attend the entire activity to receive all types of credit. Continuing Education evaluation and request for certificates will be accepted up to 60 days post activity date. CFMC will keep a record of attendance on file for 6 years.