Fraud, Waste & abuse (fwa) Compliance training

[Virtual Presenter] Welcome everyone! We are here today to discuss the important topic of FWA Compliance Training. We will discuss relevant laws that are designed to promote ethical practices in business and protect consumers. Let's get started..

[Audio] Fraud, waste and abuse are not tolerated in our company. Fraud involves deceiving, misrepresenting, or hiding information to achieve something valuable. Waste refers to excessively or inappropriately using services, misusing resources, or practices that cause unnecessary costs in federally-funded or state-funded programs. It is essential that we take the necessary steps to recognize and prevent such behavior. It is our responsibility to use our services and resources appropriately for our company and customers..

[Audio] Abuse can be related to Fraud, Waste and Abuse compliance as it entails situations when services or actions are used in an improper way that goes against accepted practice. This can result in payment for items or services, even though the intention is genuine, but at the end of the day, lead to an unnecessary cost incurred..

[Audio] Fraud, Waste & Abuse Compliance Training is of utmost importance for Home of love, LLC. This training involves abstaining from offering, soliciting, or receiving a kickback, bribe, rebate, or falsifying claims and services. Additionally, kickbacks, fraudulent enrollment practices, and fraudulent recoupment practices are also covered in this type of training. Moreover, important issues around eligibility determination such as resource misrepresentation, residency, and household composition are included in this training. To summarise, all such actions are unethical and can lead to serious legal implications, hence it is essential to understand the relevant policies..

[Audio] Compliance with the False Claims Act and the Anti-Kickback Statute is essential to run a successful business. The False Claims Act forbids knowingly submitting a false claim for reimbursement, making or utilizing an invalid document or declaration to back up a false claim, and participating in a conspiracy to do either of those activities. The Anti-Kickback Statute forbids offering, paying, requesting, or accepting anything of value to induce or remunerate allusions for items or services that can be refunded by a federal healthcare program. Anything of value, including cash or some other type of item, is considered remuneration..

[Audio] I will be discussing the Beneficiary Inducement Statute, the Self-Referral Prohibition Statute and the Red Flag Rule as part of the Fraud, Waste & Abuse Compliance Training. The Beneficiary Inducement Statute makes it illegal to provide certain incentives to Medicare beneficiaries, such as waiving coinsurance and deductible amounts if the beneficiary is in financial need. The Self-Referral Prohibition Statute, commonly known as the Stark Law, forbids physicians from referring Medicare patients to entities to which the physician or the physician's immediate family member is financially related. Lastly, the Red Flag Rule requires creditors to implement programs to detect and address any identity theft activities, patterns and practices..

[Audio] At Home of Love, LLC, we are committed to ensuring compliance with Fraud, Waste & Abuse (FWA) regulations. In particular, we are focusing on Arizona Revised Statute ARS 36-2918.01. This requires health care providers to report any suspected fraud or abuse perpetrated by members or providers. Those found to be purposely deceiving or misrepresenting with the aim of financial gain should be reported to AHCCCS. Moreover, AHCCCS has Prohibited Acts, which include presenting false, ineligible or misrepresented claims. We must ensure Home of Love is in compliance with all regulations, so let’s go over these topics and discuss how to make sure our practices are compliant..

[Audio] The Federal Deficit Reduction Act of 2005 mandates organizations like Home of Love, LLC to produce written policies about federal and state false claims laws and whistleblower protections, as well as devise procedures to detect and prevent fraud, waste, and abuse. Compliance with this law is essential for the organization to stay abreast of the existing regulations..

[Audio] Fraud, Waste & Abuse Compliance Training is of paramount importance for Home of Love, LLC. We want to make sure that our employees understand the severity of False Claim Acts and Anti-kickback Statute. According to the False Claim Act, if a false claim is detected, the provider is liable to pay a penalty of between $5000 to $10000. In case the government proves it suffered a loss due to this, the provider is responsible for three times the loss. On the other hand, Anti-kickback Statute is associated with up to five years in prison and fines of up to $25000. If a patient suffers bodily injury as a result of a scheme, the prison sentence may be higher than twenty years. Therefore, it is important that all employees are aware of the legal implications that come with committing any Fraud, Waste & Abuse..

[Audio] Fraud, waste and abuse is a very serious infraction and can have severe consequences for anyone who commits it. First, it could result in termination of employment or contract. Civil money penalties and fines may also be imposed. In addition, a criminal conviction may lead to imprisonment, exclusion from federal health care programs and loss of provider license where applicable. That’s why it's so important to understand the regulations and follow the guidelines to remain compliant..

[Audio] The Whistleblower Protection Act, or WPA, seeks to protect federal employees who report violations of laws, rules, regulations, or abuses of authority that can jeopardize public safety or funds. Moving on, we will look at specific protective measures in place for whistleblowers..

[Audio] Employees of Home of Love, LLC, should be aware of the protections provided by the Fraud, Waste & Abuse Compliance Training program. The Act ensures that they cannot be retaliated against if they report wrongdoing, fraud and abuse. The Office of Special Counsel has authority to investigate such complaints and provide remedies where necessary. It is important for employees to feel empowered to report any suspicious activity without fear of repercussions..

[Audio] You must understand your responsibility in preventing, detecting, and reporting any potential non-compliance and fraud, waste, and abuse as an employee of Home of Love, LLC. You must comply with all federal and state laws and regulations, company policies and procedures, and the company compliance program. You must report any violations to the laws, regulations, policies and procedures, and to the company’s compliance program. You must adhere to the company’s Code of Conduct, which outlines the commitment to act with integrity and other ethical rules of behavior..

[Audio] It is essential that everyone is aware of the procedures and how they can go about reporting fraud, waste, and abuse. Absolutely anyone can report fraud, abuse or member abuse, and they may remain anonymous. To do so, one can call the toll free DES/DDD Hotline or fill out an online form available on the website. I trust this training has been useful and has provided everyone with the necessary information..

[Audio] A whistleblower is someone who reveals any kind of wrongdoing or misconduct to an external party such as a regulator or government agency. It is possible to do this anonymously under the False Claims Act and, if successful, the whistleblower may receive a part of the resulting settlement. It must be remembered that employers are not allowed to threaten or take retaliatory action against whistleblowers..

[Audio] We are committed to ensuring you are informed of laws, regulations, company policies, and that our compliance program is up-to-date. We will monitor claims and billing for accuracy and verify that documentation supports the services that have been provided. To ensure continued compliance, we will conduct regular internal audits and have open lines of communication with staff. Staff are expected to report any potential compliance issues immediately and may be asked about any compliance issues in exit interviews. We appreciate your attention and trust that this presentation was useful..