Healthcare Fraud Prevention

Recent laws and government regulations have mandated certain requirements designed to reduce fraudulent and erroneous healthcare claims. For example, the federal Deficit Reduction Act of 2005 (DRA) requires employers to create written compliance policies and to educate staff about false Medicaid claims and whistleblower protections.  While the DRA does not explicitly require covered organizations to provide formal training, some states have passed laws that do require formal training of all personnel on Medicaid and other health care fraud.

Organizations that receive payments for fraudulent or erroneous claims may face numerous penalties, including exclusion from participation in government healthcare programs.

All healthcare providers should provide periodic training on this topic. 

Entities should train all employees, contractors, and agents.

Brightline's online course, Healthcare Fraud Prevention, provides accurate, practical, and engaging instruction on topics such as:

• The purpose of the False Claims Act, the Deficit Reduction Act, and other laws that impact healthcare fraud
• Responsibilities of organizations to avoid fraud and reduce erroneous claims
• Responsibilities of individual employees, contractors, subcontractors, vendors and other agents to avoid fraud and reduce erroneous claims
• Standards for proper recording and reporting of claims
• How to report a fraudulent or erroneous claim, or other concern
• Legal and organizational protections for whistleblowers from retaliation