ATI Health Care Fraud, Waste and Abuse Prevention

ATI Health Care Fraud, Waste and Abuse Prevention 1. When an employee in a provider’s office suspects fraudulent activity and uses the Office of Inspector General (OIG) Hotline to report it, the employee should do which of the following? -Stop filing suspicious bills and claims. (The employee should stop filing the problematic bills immediately to avoid additional fraud.) -Pursue knowledgeable legal counsel. (While the Qui Tam statute forbids employers from harassing or retaliating against an employee for reporting fraud, the employee must prepare to deal with such issues. Sources of support and protection, such as having a legal representative, may help with this process. -Disengage professionally with the suspected perpetrator. (For the employee’s personal safety, the recommendation after reporting suspected fraud is to disengage professionally from the person the employee reported to whatever extent is possible in the situation.) -Report and return overpayments. (The employee should determine what money was collected in error from patients and from the federal health care programs and report and return overpayments.) 2. Which piece of legislation mandated the establishment of a joint Health Care Fraud and Abuse Control (HCFAC) program? Health Insurance Portability and Accountability Act (HIPAA) HIPAA established the existing interdepartmental relationships between the US Department of Health and Human Services Office of Inspector General (OIG), the Attorney General, and the Department of Justice (DOJ), which together manage the Health Care Fraud and Abuse Control (HCFAC) Program. 3. Health Insurance Portability and Accountability Act (HIPAA) mandated that health care entities implement which of the following strategies to help reduce the Medicare fee-for-service error rate and prevent payment for potential fraudulent activity? Electronic Health Records Electronic Health Records reduce the errors from illegible or missing signatures on bills entities submit to health care insurance agencies. Plus, compared with manual records, they are far more likely to contain all the documentation to support the claim. 4. Which of the following agencies of the US government has the authority to exclude individuals and entities from participating in federal health care programs? Office of Inspector General (OIG) The OIG has the authority to exclude individuals and entities from federal health care programs for fraud and abuse that affect these programs or their beneficiaries. 5. Which of the following is an example of a best practice strategy to prevent fraud, waste and abuse? Establish procedures for maintaining and distributing medication supplies. If health care providers accept free drug samples from manufacturers, a best practice strategy to prevent fraud, waste and abuse entails establishing procedures to prevent providers or employees from using free samples for personal gain (such as selling them).