Essentials of Medicare Fraud, Waste, and Abuse Training

Components of Medicare Fraud, Waste, and Abuse Training

One of the most important elements of CMS Medicare fraud, waste, and abuse training is defining and differentiating these three terms:

• Fraud is the deliberate attempt to obtain financial gain through deceptive means, such as providing false information. Examples of Medicare fraud include billing for unrendered services and using a billing code or a service that’s more expensive than what a patient received.
• Waste refers to behaviors that directly or indirectly lead to excessive costs. Waste can be unintentional and not necessarily criminal. People commit waste when they overuse services, order unnecessary tests, or bill for one procedure more than once.
• Abuse also results in unnecessary expenses, whether direct or indirect. Examples of Medicare abuse are providing false documentation to justify a claim or paying for services patients didn’t receive.

Other aspects of Medicare compliance training include the necessary steps to identify, prevent, and report noncompliance incidents. Individuals who complete training also become aware of the federal laws applicable to healthcare workers and settings and know how to apply them in workplace settings.

Consequences of Noncompliance

The outcomes resulting from regulatory noncompliance can devastate an organization, so regular training for all personnel is crucial. Violations of regulations regarding Medicare fraud, waste, and abuse can result in fines, license revocation, and other legal ramifications. Moreover, a noncompliant organization can be added to the OIG exclusion list – organizations excluded from Medicare, Medicaid, and other federal programs.

Repercussions of noncompliance can also hurt an organization’s bottom line. Hospitals and other healthcare entities that don’t successfully prevent fraud, waste, and abuse face cybersecurity and privacy threats, decreased productivity, and loss of credibility within their communities and the healthcare field.

Learning Management Systems to Support Medicare Compliance Training

You need effective communication and organization to help your staff fulfill their requirements for CMS Medicare fraud, waste, and abuse training. It also relies on streamlining tools like a learning management system (LMS). Due to the increasing reliance on technology, traditional training methods are becoming less effective. That’s why an LMS can be a powerful resource to help your organization stay on top of evolving training requirements.

A quality LMS has a dashboard that keeps all compliance-related activities centralized, making it easier for employees to access the right training content and complete training renewals on time. More specifically, an LMS can provide the following features and functions:

• Store all training content in one location to make it easier for individuals to access relevant modules
• Automate administrative tasks
• Track employees’ training progress and completion rates
• Record test scores
• Store compliance documents, training materials, and procedures
• Customize and expand training modules
• Issue completion certificates