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HIPAA, Fraud, And Abuse

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5 Videos
4.3 Hours
105 Test Questions

Course Description

HIPAA, Fraud, And Abuse

HIPAA (Health Insurance Portability and Accountability Act):

HIPAA, enacted in 1996, protects patients’ sensitive health information from unauthorized disclosure. Its main components are:

  • Privacy Rule: Protects individuals’ medical records and personal health information (PHI), giving patients rights over their health data.
  • Security Rule: Sets standards for securing electronic PHI (ePHI) with administrative, physical, and technical safeguards.
  • Breach Notification Rule: Requires notification to affected individuals and authorities following a breach of unsecured PHI.
  • Enforcement Rule: Provides standards for compliance and penalties for violations.

Healthcare Fraud and Abuse:

Healthcare fraud and abuse involve illegal acts for financial gain, leading to higher costs and compromised care.

  • Fraud: Intentional deception for unauthorized benefits, such as billing for unprovided services or falsifying diagnoses.
  • Abuse: Practices leading to unnecessary costs, like providing non-essential services or misusing codes.

Anti-Fraud Measures:

  • False Claims Act (FCA): Imposes liability on those defrauding government programs, with whistleblower provisions.
  • Stark Law: Prohibits physician self-referrals to entities with financial ties.
  • Anti-Kickback Statute (AKS): Bans remuneration for referrals covered by federal healthcare programs.
  • Compliance Programs: Encourages organizations to implement policies, training, auditing, and communication channels to prevent fraud and abuse.

Adhering to HIPAA and combating fraud and abuse ensures patient data protection, fair resource allocation, and high-quality care.


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Step-by-Step Courses List

Chapter One:

Module 1: HIPPA and Privacy

  1. HIPPA and Privacy
  2.  Security, Safeguards, and Controls
  3.  Examples and Cases
Chapter Two:

Module 2: Fraud, Waste, and Abuse

  1.  Fraud, Waste, and Abuse
  2.  Case Examples and Law
Chapter Three:

Module 3: Compliance and Prevention

  1.  Compliance and Prevention

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course Syllabus

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Frequently Asked Questions

Instructional methods, course requirements, and learning technologies can vary significantly from one online program to the next, but the vast bulk of them use a learning management system (LMS) to deliver lectures and materials, monitor student progress, assess comprehension, and accept student work. LMS providers design these platforms to accommodate a multitude of instructor needs and preferences.

Online education may seem relatively new, but years of research suggests it can be just as effective as traditional coursework, and often more so. According to a U.S. Department of Education analysis of more than 1,000 learning studies, online students tend to outperform classroom-based students across most disciplines and demographics. Another major review published the same year found that online students had the advantage 70 percent of the time, a gap authors projected would only widen as programs and technologies evolve.

All new learning innovations are met with some degree of scrutiny, but skepticism subsides as methods become more mainstream. Such is the case for online learning. Studies indicate employers who are familiar with online degrees tend to view them more favorably, and more employers are acquainted with them than ever before. The majority of colleges now offer online degrees, including most public, not-for-profit, and Ivy League universities. Online learning is also increasingly prevalent in the workplace as more companies invest in web-based employee training and development programs.

The concern that online students cheat more than traditional students is perhaps misplaced. When researchers at Marshall University conducted a study to measure the prevalence of cheating in online and classroom-based courses, they concluded, “Somewhat surprisingly, the results showed higher rates of academic dishonesty in live courses.” The authors suggest the social familiarity of students in a classroom setting may lessen their sense of moral obligation.

Choosing the right course takes time and careful research no matter how one intends to study. Learning styles, goals, and programs always vary, but students considering online courses must consider technical skills, ability to self-motivate, and other factors specific to the medium. Online course demos and trials can also be helpful.
Our platform is typically designed to be as user-friendly as possible: intuitive controls, clear instructions, and tutorials guide students through new tasks. However, students still need basic computer skills to access and navigate these programs. These skills include: using a keyboard and a mouse; running computer programs; using the Internet; sending and receiving email; using word processing programs; and using forums and other collaborative tools. Most online programs publish such requirements on their websites. If not, an admissions adviser can help.

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Description

HIPAA, Fraud, And Abuse

HIPAA (Health Insurance Portability and Accountability Act):

HIPAA, enacted in 1996, protects patients’ sensitive health information from unauthorized disclosure. Its main components are:

  • Privacy Rule: Protects individuals’ medical records and personal health information (PHI), giving patients rights over their health data.
  • Security Rule: Sets standards for securing electronic PHI (ePHI) with administrative, physical, and technical safeguards.
  • Breach Notification Rule: Requires notification to affected individuals and authorities following a breach of unsecured PHI.
  • Enforcement Rule: Provides standards for compliance and penalties for violations.

Healthcare Fraud and Abuse:

Healthcare fraud and abuse involve illegal acts for financial gain, leading to higher costs and compromised care.

  • Fraud: Intentional deception for unauthorized benefits, such as billing for unprovided services or falsifying diagnoses.
  • Abuse: Practices leading to unnecessary costs, like providing non-essential services or misusing codes.

Anti-Fraud Measures:

  • False Claims Act (FCA): Imposes liability on those defrauding government programs, with whistleblower provisions.
  • Stark Law: Prohibits physician self-referrals to entities with financial ties.
  • Anti-Kickback Statute (AKS): Bans remuneration for referrals covered by federal healthcare programs.
  • Compliance Programs: Encourages organizations to implement policies, training, auditing, and communication channels to prevent fraud and abuse.

Adhering to HIPAA and combating fraud and abuse ensures patient data protection, fair resource allocation, and high-quality care.


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