Civil vs Criminal Medicaid Medicare Fraud

Description

An estimated 60% of healthcare organizations have faced at least one CMS payer audit, per a recent study.  In 2021, alone, 336 individuals were convicted for health care fraud.  Of those fraud cases, the average “loss” reported was estimated to be in excess of $1M.  73.5% of individuals convicted of fraud were sentenced to prison, with an average “guideline term” of 52 months.  This is alarming in the healthcare industry as more businesses are being audited at a higher rate as an ongoing trend.

Attendees will leave this course with an understanding of civil and criminal healthcare fraud investigations stemming from these audits, the governing laws, and how they can best prepare for the day their business or provider may be audited.

Area Covered In The Webinar

Types of healthcare fraud; healthcare investigation “possibilities”; the seriousness of healthcare fraud investigations; the healthcare fraud investigation process; Fraud and Abuse Laws & Exceptions; How providers can protect themselves from healthcare fraud investigations

Who Will Benefit?

• Providers
• Compliance Professionals
• Medical Coders
• Physicians
• Behavioral Health Providers
• Other Medical Providers
• Individuals with financial stakes in healthcare businesses.