Welcome back to Accountable's fraud, waste and abuse training series. In this video, we're shifting from understanding laws to actively preventing, detecting and reporting FWA.
Prevention starts with you. By integrating best practices into your daily routines, you play a crucial role in protecting patients, preserving resources, and ensuring integrity. Every day prevention means following simple critical steps such as safeguarding your login credentials, verifying billing accuracy and diligently documenting services provided. But what should you actually look out for?
Here are some common red flags that might indicate fraud, waste or abuse. Watch for unnecessary procedures. Now these can signal waste or abuse. Falsified documentation or up coding patient visits can indicate fraud.
Be cautious of unusual incentives or gifts from vendors which could be illegal kickbacks. If you spot something questionable, your next step is crucial. Reporting your concerns safely and confidentially. Your organization provides clear channels to report potential FWA, a compliance hotline, an anonymous online reporting form, or directly contacting your compliance officer.
Remember, timely reporting is essential and it's protected. Your organization strictly prohibits retaliation against anyone reporting FWA in good faith. Now let's put your knowledge into practice. Imagine you notice a coworker consistently billing services at higher levels than actually performed.
Is this fraud, waste, abuse or a simple error?
Correct. This situation suggests fraud due to deliberate misrepresentation. Now consider frequent unnecessary testing. Fraud, waste, abuse or error.
Exactly. This scenario represents waste as resources are used unnecessarily. Understanding these distinctions equips you to act decisively. And remember, if you're ever unsure, report it.
Your compliance team will investigate and ensure appropriate action. Also, remember whistleblower protections exist. Reporting significant concerns externally can lead to rewards under laws like the False Claims Act. Your active role in preventing, detecting, and reporting fraud, waste, and abuse makes a tangible difference every day.
Next, we'll wrap up our series by reviewing real consequences and reinforcing your critical role in compliance. Thanks for staying vigilant, responsible and accountable.
