The Need To Provide Medicare Training Courses To Employees

 It has been estimated in 2018 that annual Medicare costs exceeded  $3.35 trillion and losses due to fraud and abuse reached $300 Billion. Healthcare fraud is a costly affair. Every year billions of dollars are wasted due to healthcare fraud.

Medicare training programs have been initiated to make aware people of all the practices of fraud and abuse.

It does not make any difference whether a person has employer-sponsored health insurance or his own health insurance policy, healthcare fraud and abuse culminates in higher premiums and out-of-pocket expenses for customers, along with reduced benefits and coverage. From the perspective of employers, healthcare fraud and abuse escalate the cost of providing insurance benefits to employees and the overall cost of running the business.

With medicare training courses, employees can learn to recognize the most recurrent forms of abuse and fraud including physician self-referrals (stark law), kickbacks, and false claims. It is extremely crucial for an organization to actively participate in circulating essential information related to healthcare fraud and abuse to avoid any repercussions.

How to characterize Medicare fraud and abuse?

According to HIPAA, fraud is characterized as an intentional execution of a scheme or plan intended to defraud any healthcare program by means of fraudulent practices. Abuse can be identified by certain practices that culminate in the overpayment to the healthcare provider. The most common practices include misrepresentation of services including charging for services not rendered, alterations in claim forms for charging higher payments, fabrication of information in medical record documents, misrepresentation of the types of services rendered, charging for supplies not given, rendering services that are unnecessary for the medical condition of patients.

Medicare compliance training courses: An overview

Medicare training programs have been formulated to recapitulate principle laws, which are beneficial to combat fraud and abuse against several healthcare programs, including the False Claim Act, Anti-Kickback Statute, and the Stark Law. The training program also includes the employer’s responsibilities in the prevention of fraud and abuse through the foundation of compliance programs, which help in recognizing and preventing any sort of fraud and abuse. These courses have been formulated for the employees working in healthcare organizations who should be enlightened about the fundamentals regarding medicare fraud and abuse.

Medicare training programs provide a review of all the laws that can be used to tackle fraud and abuse against several government medicare programs and includes information related to-

●      False Claims Act

●      Anti-Kickback Statute

●      Physician Self-Referral “Stark Statute”

●      Fraud Enforcement and Recovery Act of 2009

●      Patient Protection and Affordable Care Act

●      Deficit Reduction Act of 2005

What are the objectives of Medicare compliance training courses?

 1.     Providing complete information regarding the difference between fraud and abuse.

2.     Providing information related to principle laws that can be used to combat health care fraud and abuse

3.     To make employees identify the components of medicare fraud.

4.     Description of a compliance plan to prevent false claims.

5.     Complete information to avoid False Claim Act violations.

Final words

Healthcare providers and organizations should invest in medicare training courses to spread awareness about any types of medicare fraud and abuse and the government should also not condone medicare organizations, providers, manufacturers, and individuals who hold onto fraud and abuse practices in an organized manner.