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Avoiding Healthcare Fraud, Waste and Abuse

Health care reform and the Affordable Care Act, also known as Obama Care, require all providers to have a written compliance program (fraud, waste and abuse) in place. You are required to train your staff within 90 days of employment and every year thereafter.

NOTICE:  To be completely clear, if Medicare requires it, all other state and private-payer programs do ALSO.  Follow the Medicare guides on compliance, fraud, waste and abuse (FWA) at all times.

Are you compliant?

Compliance Programs For Physicians

Establishing and following a compliance program will help physicians avoid fraudulent activities and ensure that they submit true and accurate claims.

The following seven components provide a solid basis upon which a physician practice can create a voluntary compliance program:

1. Conduct internal monitoring and auditing;

2. Implement compliance and practice standards;

3. Designate a compliance officer or contact;

4. Conduct appropriate training and education;

5. Respond appropriately to detected offenses and develop corrective action;

6. Develop open lines of communication with employees; and

7. Enforce disciplinary standards through well-publicized guidelines


Section 6401(a)(7) of the Affordable Care Act requires physicians who treat Medicare beneficiaries to establish a compliance program

To read more:  Avoiding Fraud, Waste and Abuse

Anti-Fraud, Waste and Abuse Policies Manual, Code of Conduct and Training Materials

Includes Self Audit Program:  Conducting a Self-Audit and Forms

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