Preventing Healthcare Fraud, Waste, and Abuse: Why Training and Compliance Matter
Billions of dollars are wasted annually due to healthcare Fraud, Waste, and Abuse (FWA), impacting everyone. Training and implementing effective compliance programs are crucial to detecting, correcting, and preventing FWA, protecting Medicare enrollees and the healthcare system. Non-compliance risks harm to beneficiaries, resulting in delayed services, denial of benefits, and financial repercussions for all. Reporting non-compliance is encouraged without fear of retaliation. Contact details for reporting are provided.
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Presentation Transcript
Healthcare Fraud, Waste, and Abuse Physician Education
Why Do I Need Training? Every year billions of dollars are improperly spent because of Fraud, Waste, and Abuse (FWA). It affects everyone including you. This training helps you detect, correct, and prevent FWA. You are part of the solution. Compliance is everyone s responsibility. As an individual who provides health or administrative services for Medicare enrollees, your every action potentially affects Medicare enrollees, the Medicare Program, or the Medicare Trust Fund. 2
What is an Effective Compliance Program? An effective compliance program fosters a culture of compliance within an organization and, at a minimum: Prevents, detects, and corrects non-compliance; Is fully implemented and is tailored to an organization s unique operations and circumstances; Has adequate resources; Promotes the organization s Standards of Conduct; and Establishes clear lines of communication for reporting noncompliance. An effective compliance program is essential to prevent, detect, and correct Medicare non-compliance as well as Fraud, Waste, and Abuse (FWA). It must, at a minimum, include the seven core compliance program requirements. 3
Non Compliance Affects Everybody Without programs to prevent, detect, and correct non- compliance, we all risk harm to beneficiaries, such as: Delayed services Denial of benefits Less money for everyone, due to: High insurance copayments Higher premiums Lower benefits for individuals 4
Dont Hesitate to Report Non- Compliance There can be no retaliation against you for reporting suspected non-compliance in good faith. You may do this Anonymously; Confidentially; and Non-retaliatory You may call the Summa Health Compliance Officer at: 330-996-8437; or send an email to her at mitchelld@summahealth.org or Call the Summa Health Hotline at 1-800- 421-0925 5
