PPT-Module 10 Medicare and Medicaid Fraud and Abuse Prevention

2016 National Training Program Session Objectives This session should help you Define fraud and abuse Identify causes of improper payments Discuss how CMS fights fraud and abuse Explain how you can fight fraud and abuse. Developed by the Centers for Medicare & Medicaid Services . Issued. : February, 2013. This training module consists of two parts: (1) Medicare Parts C & D Fraud,. Waste, and Abuse (FWA) Training and (2) Medicare Parts C & D General . Fraud, Waste and Abuse . Part I:. Overview. Objectives. . Convey GuildNet’s commitment to compliance.. Explain obligations of GuildNet’s. . first tier, downstream, and related entities to prevent, detect, and report fraud, waste and abuse.. Medicare Fraud & Abuse: . Prevention, Detection, and Reporting. 2. Disclaimers. . This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference.. Chicago Regional Office. Centers for Medicare Health Plan Operations. Yolanda Burge-Clark. August 19, 2014. 10 million (aprox) individuals that are enrolled in both Medicare and Medicaid (or “dual eligibles”).. Senior Medicare Patrol. LTC Ombudsman Program . 2014-2015. . Funded by the U.S. . Department of . . Health & Human Services – . Administration on Community Living. Administration on Aging established 12 demonstration projects . Presentation Outline. Overview of the Affordable Care Act. The Marketplace/Connect for Health Colorado. Medicare and the ACA. What is the Affordable Care Act (ACA). Refers to the . federal laws and regulations contained in the Patient Protection and Affordable Care Act and the subsequent Health Care and Education Reconciliation Act have come to be called the Affordable Care Act (ACA). . Physician Education. 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 . Fraud, Waste and Abuse. . (FWA). Training. 12/11/2013. FRAUD, WASTE AND ABUSE (FWA). EXECPTION-NOTICE. There is one exception to the FWA training and education requirement. Regulations effective June 7, 2010 implemented a “deeming” exception which exempts FDRs who are enrolled in Medicare Parts A or B from annual FWA training and education. Therefore, if an entity or an individual is enrolled in Medicare Parts A or B, the FWA training and education requirement has already been satisfied. If you are unsure if this “deeming” exception applies to you please contact an IEHP Compliance Manager at . Module 10. Medicare . and Medicaid Fraud and Abuse Prevention. Session Objectives. This session . should . help you . Define fraud . and abuse . Identify causes of improper payments. Discuss how CMS. Presented by Statewide Health Insurance Benefits Advisors (SHIBA), Washington state’s SMP SMP program funded by the U.S. Administration for Community Living Take Charge… Help Prevent Health Care Fraud and Abuse! 2016 National Training Program. Session Objectives. This session should help you . Define fraud and abuse . Identify causes of improper payments. Discuss how CMS. fights fraud and abuse. Explain how you can fight fraud and abuse. 2020. Please review the notes section of each slide for additional information and details.. Publicly-funded insurance program. Americans age 65 and over. Disabled Americans. A Medicare plan may include:. New Hire and Annual Employee Compliance Training. CTS Introduction. Coordinated Transportation Solutions, Inc.. CTS is a 501(c)(3) not-for-profit entity founded in Connecticut in 1997. We manage non-emergency transportation programs for government agencies, managed care organizations, school districts and businesses throughout the northeast and mid-Atlantic region. We do not have drivers and vehicles of our own that perform trips. Rather, we coordinate transportation using a network of credentialed and contracted, local transportation companies. . EXCEL MSO seeks to uphold the highest ethical standards for the provision of health care benefits and services to its members and supports the efforts of health plans, federal, and state authorities in their enforcement of prohibitions of fraudulent practices by providers, members, or other entities dealing with the provision of health care services..