Every day we hear reports of physicians facing the threat of civil or even worse, criminal actions because of simple errors and lack of knowledge regarding Medicare rules and regulations. Unfortunately, carriers can view this lack of necessary knowledge as a "Reckless Disregard" of the regulations.

Who is audited?

No one is immune to the challenges of fraud and abuse. Today, it's not "if we are audited" it's "when we are audited."

Not only do you face significant federal and state program audit risks, you are also under the scrutiny of private third party payors. You can't stick your head in the sand any longer!

The yearly OIG work plan has been released - learn the latest targets that will impact the physicians practice.

Even though you don't leave your home each morning rubbing your hands with glee saying "Today I am going to defraud the system!", your coding, billing and documentation practices may say otherwise. They may fit a carrier profile of fraudulent or abusive patterns. You must prepare now!

Topics

This course is designed to show you what the auditors look for. Don't be caught unaware. Become informed of your rights as well as your responsibilities. Learn what is considered to be fraud and abuse, and gain an understanding of how to prevent the accidental implication of each.

• The Medicare Contract. What are your responsibilities?
• What are the fines and penalties? Have they increased?
• What to do when the auditor arrives. Do you know your rights?
• Are you aware that Medicare is conducting pre-payment audits? What does this mean to you?

WHAT IS FRAUD AND ABUSE? GET THE FACTS!

• What triggers an audit?
• Who gets audited and why audits are conducted?
• How fines are assessed?
• Medicare Illegal Remuneration Statute: How does it affect you?
• Why can't you routinely waive the Medicare patient's co-pay? Could it really be considered a kickback under Medicare's "Anti-Kickback Statute"?
• What does HIPAA (Health Insurance Portability and Accountability Act) and the Balanced Budget Act of 1997 have to do with fraud and abuse?
• Overpayments? Can you, should you wait until they ask for the money back?

CARRIER AUDITS

• What to do when the letter, "You owe $5,000" arrives?
• Post Audit Action - the adverse finding. What are the effects of the adverse

Objectives

AUDIT TRIGGERS

Some of the audit triggers that will be covered are:

• Billing Patterns - when you look at the actual statistical analysis from your billing patterns and use or lack of use of correct CPT and ICD-9-CM codes, you may find that you have fallen into the "Audit Trap."
• Patient complaints - could the problem be miscommunication? What should you do?
• Information from other investigations - learn how and why you may be drawn into an investigation as well as find out who can investigate you.
• Billing errors and data from claims processing - believe it or not, you provide the information. It comes right off of the claim form.

Get the facts today!

Be aware that penalties are not limited to monetary figures but could include exclusion as a provider, imprisonment as well as loss of reputation. The "Avoiding Fraud and Abuse" seminar is a must because you need to know how to protect yourself and the future of your practice.