Healthcare Fraud, Waste, and Abuse

Who should take it

Everyone who documents services, codes, bills, schedules or supervises in a practice that bills Medicare, Medicaid or other health plans.

National course on federal fraud and abuse laws. Many states have their own false claims and anti-kickback laws, and each payer has its own billing rules. This course is education, not legal advice.

What employees will learn

• ✓Distinguish fraud, waste and abuse, and recognize where honest mistakes fit.
• ✓Explain the basics of the False Claims Act, including what "knowingly" means.
• ✓Recognize arrangements that may violate the Anti-Kickback Statute or beneficiary inducement rules.
• ✓Identify common improper billing practices: upcoding, unbundling, services not rendered, and falsified or cloned documentation.
• ✓Describe what the exclusion list is and why practices check it.
• ✓Explain the duty to report and return overpayments.
• ✓Report concerns through the right channels and describe whistleblower protections.

Topics covered

• •Fraud, waste, and abuse distinctions
• •False Claims Act principles
• •Improper billing
• •Upcoding
• •Unbundling
• •Services not rendered
• •Documentation falsification
• •Reporting concerns
• •Nonretaliation

Sources this course is based on

• False Claims Act: liability, definitions of knowing and claim (31 U.S.C. 3729) · Other
• False Claims Act: relief from retaliatory actions (31 U.S.C. 3730(h)) · Other
• Anti-Kickback Statute: illegal remunerations (42 U.S.C. 1320a-7b(b)) · Other
• Anti-Kickback safe harbors (42 CFR 1001.952) · eCFR
• Reporting and returning of overpayments (42 U.S.C. 1320a-7k(d)) · Other
• Medicare: requirements for reporting and returning overpayments (CY2025 revisions) (42 CFR 401.305) · eCFR
• Deficit Reduction Act section 6032: employee education about false claims recovery (42 U.S.C. 1396a(a)(68)) · Other
• Medicare Advantage compliance program: training and education (42 CFR 422.503(b)(4)(vi)(C)) · eCFR