Banner Health Compliance Training

Fraud, Waste, and Abuse Examples of actions that may constitute abuse include: ● Unknowingly billing for unnecessary medical services ● Unknowingly billing for brand name drugs when generics are dispensed ● Excessively charging for services or supplies without intent ● Unknowingly using incorrect codes on a claim, such as upcoding or unbundling codes How Do You Prevent Fraud, Waste, and Abuse? ● Look for suspicious activity ● Conduct yourself in an ethical manner ● Ensure accurate and timely documentation, coding, and billing ● Know the Code of Conduct, compliance policies, laws, regulations, and CMS guidance ● Verify all received information How Do You Correct Fraud, Waste, and Abuse? Once fraud, waste, or abuse is detected, promptly correct it. Correcting the problem saves the government money and ensures your compliance with Federal health care program requirements. It is important to develop a plan to correct the issue. The actual plan is going to vary, depending on the specific circumstances.