What are the examples of issues that should be reported to a compliance department?

What are the examples of issues that should be reported to a compliance department?

These are examples of issues that can be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct..

Which of the items listed are examples of fraud waste and abuse FWA )? Select 3?

Examples of Fraud, Waste and Abuse

• Billing for services not rendered.
• Altering medical records.
• Use of unlicensed staff.
• Drug diversion (e.g. dispensing controlled substances with no legitimate medical purpose)
• Kickbacks and bribery.
• Providing unnecessary services to members.

Which of the following are ways to report potential fraud waste and abuse FWA )?

Fraud, Waste and Abuse (FWA)

• Fraud Hotline: 1-800-488-0134 (Follow the prompts for reporting Fraud)
• Written Report: Use the Fraud, Waste and Abuse Reporting Form on www.caresource.com or write a letter and send to:

Is standards of conduct are the same for every Medicare Parts C and D sponsor?

Standards of Conduct are the same for every Medicare Parts C and D Sponsor.

What are examples of issues that should be reported to the Ethics & compliance Office?

These are examples of issues that can be reported to a Compliance Department: suspected Fraud, Waste, and Abuse (FWA); potential health privacy violation, and unethical behavior/employee misconduct.

What is an example of abuse?

Examples include intimidation, coercion, ridiculing, harassment, treating an adult like a child, isolating an adult from family, friends, or regular activity, use of silence to control behavior, and yelling or swearing which results in mental distress.

What is abuse in fraud waste and abuse?

Well, fraud is when someone intentionally lies to a health insurance company, Medicaid or Medicare to get money. Waste is when someone overuses health services carelessly. And abuse happens when best medical practices aren’t followed, leading to expenses and treatments that aren’t needed.

What is waste in fraud waste and abuse?

Is unknowingly misusing codes on a claim an example of fraud waste or abuse?

Unknowingly misusing codes on a claim, such as upcoding or unbundling codes. There are differences among fraud, waste and abuse. One of the primary differences is intent and knowledge. Fraud requires intent to obtain payment and the knowledge that the actions are wrong.

What are some of the laws governing Medicare Parts C and D?

Some of the laws governing Medicare Parts C and D Fraud, Waste, and Abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA); the False Claim Act; the Anti-Kickback Statute; the List of Excluded Individuals and Entities (LEIE); and the Health Care Fraud Statute.