What is Medical Fraud, Waste, and Abuse (FWA)?
Fraud – Is the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s).
Fraud involves making false statements or misrepresentation of material facts in order to obtain some benefit or payment for which no entitlement would otherwise exist. The acts may be committed for the person’s own benefit or for the benefit of another party. In order to be considered fraud, the act must be performed knowingly, willfully, and intentionally.
Waste – An attempt to obtain reimbursement for items or services where there was no intent to deceive or misrepresent, but the outcome of a billing error caused unnecessary costs to the involved companies. Waste includes overutilization of services not caused by criminally negligent actions. Waste also involves the misuse of resources.
Waste means over-utilization of services or practices that result in unnecessary costs. Waste also refers to useless consumption or expenditure without adequate return or an act or instance of wasting.
Abuse – Describes provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in:
- An unnecessary cost to the Medicaid and Medicare program;
- Reimbursement for services that are not medically necessary; or
- Services that fail to meet professionally recognized standards for health care.
It also includes recipient practices that result in unnecessary cost to the Medicaid and Medicare program. Abuse is similar to fraud except that there is no requirement to prove or demonstrate that abusive acts were committed knowingly, willfully, and intentionally.
Certificate for Continuing Education Credits:
Students can buy a 1.5 CE credits certificate for this course at the time of registration. You will receive one CE credit for this course through the Approved Provider of California Board of Registered Nursing after completing the course.
Email us now at Bob@hipaatraining.net or call (515) 865-4591 if you have any questions about this course and who should take this course.