{"id":26264,"date":"2021-01-15T06:49:13","date_gmt":"2021-01-15T06:49:13","guid":{"rendered":"http:\/\/onlineclassesguru.com\/?p=26264"},"modified":"2021-01-15T06:49:13","modified_gmt":"2021-01-15T06:49:13","slug":"what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program","status":"publish","type":"post","link":"https:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/","title":{"rendered":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?"},"content":{"rendered":"<style type=\"text\/css\"><\/style><h4>WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?<\/h4>\n<p>Review below on Title II and Healthcare Fraud and Abuse information and answer the following questions:<\/p>\n<p>What is a false claim?<br \/>\nAre mistakes and errors considered to be fraudulent behavior?<br \/>\nWhat is the purpose of a Compliance Program?<br \/>\nThere are seven steps to the compliance program. Think about your role in insurance billing. Describe the steps where you will be able to have the greatest impact to help avoid creating erroneous and fraudulent claims. What are some best practices you could implement within these steps to ensure you are adhering to Title II?<br \/>\nRequire in 150 words APA format, reference search via website.<\/p>\n<p>****************************************************<\/p>\n<p>HIPAA Title II\u0094Preventing Health Care Fraud and Abuse<\/p>\n<p>HIPAA defines fraud as \u009can intentional deception or misrepresentation that someone makes, knowing it is false, that could result in an unauthorized payment.\u009d The attempt itself is considered fraud, regardless of whether it is successful. Abuse \u009cinvolves actions that are inconsistent with accepted, sound medical, business, or fiscal practices. Abuse directly or indirectly results in unnecessary costs to the program through improper payments.\u009d The difference between fraud and abuse (Table 5-2) is the individual\u2019s intent; however, both have the same impact in that they steal valuable resources from the healthcare industry.<\/p>\n<p>When a Medicare provider commits fraud, an investigation is conducted by the Department of Health and Human Services (DHHS) Office of the Inspector General (OIG). The OIG Office of Investigations prepares the case for referral to the Department of Justice for criminal and\/or civil prosecution. A person found guilty of Medicare fraud faces criminal, civil, and\/or administrative sanction penalties, including:<\/p>\n<p>Civil penalties of $20,000 per false claim plus triple damages under the False Claims Act. (The provider pays an amount equal to three times the claim submitted, in addition to the civil penalties fine.)<br \/>\nCriminal fines and\/or imprisonment of up to 10 years if convicted of the crime of healthcare fraud as outlined in HIPAA or, for violations of the Medicare\/Medicaid Anti-Kickback Statute, imprisonment of up to 10 years and\/or a criminal penalty fine of up to $100,000.<br \/>\nAdministrative sanctions, including up to a $20,000 civil monetary penalty per line item on a false claim, assessments of up to triple the amount falsely claimed, and\/or exclusion from participation in Medicare and state healthcare programs.<br \/>\nIn addition to these penalties, those who commit healthcare fraud can also be tried for mail and wire fraud.<\/p>\n<p>TABLE 5-2 Fraud and abuse examples and possible outcomes<\/p>\n<p>EXAMPLES OF FRAUD POSSIBLE OUTCOMES OF FRAUD<br \/>\n\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Accepting or soliciting bribes, kickbacks, and\/or rebates<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Altering claims to increase reimbursement<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Billing for services or supplies not provided<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Misrepresenting codes to justify payment (e.g., upcoding)<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Entering a health insurance identification number other than the patient\u2019s to ensure reimbursement<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Falsifying certificates of medical necessity, plans of treatment, and\/or patient records to justify payment<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Administrative sanctions<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Civil monetary penalties<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Exclusion from the health program (e.g., Medicare)<\/p>\n<p>\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Referral to the Office of Inspector General<\/p>\n<p>o\u00c2 \u00c2 \u00c2 \u00a2 Exclusion from Medicare program<\/p>\n<p>o\u00c2 \u00c2 \u00c2 \u00a2 Sanctions and civil monetary penalties<\/p>\n<p>o\u00c2 \u00c2 \u00c2 \u00a2 Criminal penalties (e.g., fines, incarceration, loss of license to practice, restitution, seizure of assets)<\/p>\n<p>EXAMPLES OF ABUSE POSSIBLE OUTCOME OF ABUSE<br \/>\n\u00c2\u00b7\u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00c2 \u00a2 Billing<\/p>\n<p><center><a href=\"http:\/\/onlineclassesguru.com\/orders\/ordernow\"><img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcTyj99p60XCLyLk1htB7-1neRt8-2QdnenNlQ&usqp=CAU\"target=\"_http:\/\/onlineclassesguru.com\/orders\/ordernow\"\/><\/center><p>","protected":false},"excerpt":{"rendered":"<p>WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM? Review below on Title II and Healthcare Fraud and Abuse information and answer the following questions: What is a false claim? Are mistakes and errors considered to be fraudulent behavior? What is the&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-26264","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM? - onlineclassesguru<\/title>\n<meta name=\"description\" content=\"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM? - onlineclassesguru\" \/>\n<meta property=\"og:description\" content=\"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?\" \/>\n<meta property=\"og:url\" content=\"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/\" \/>\n<meta property=\"og:site_name\" content=\"onlineclassesguru\" \/>\n<meta property=\"article:published_time\" content=\"2021-01-15T06:49:13+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"admin_admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebSite\",\"@id\":\"https:\/\/onlineclassesguru.com\/#website\",\"url\":\"https:\/\/onlineclassesguru.com\/\",\"name\":\"onlineclassesguru\",\"description\":\"Cheap Professional coursework and reaction papers help\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/onlineclassesguru.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/#webpage\",\"url\":\"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/\",\"name\":\"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM? - onlineclassesguru\",\"isPartOf\":{\"@id\":\"https:\/\/onlineclassesguru.com\/#website\"},\"datePublished\":\"2021-01-15T06:49:13+00:00\",\"dateModified\":\"2021-01-15T06:49:13+00:00\",\"author\":{\"@id\":\"https:\/\/onlineclassesguru.com\/#\/schema\/person\/1831fa4d28e47b468621cf27932f5742\"},\"description\":\"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?\",\"breadcrumb\":{\"@id\":\"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/onlineclassesguru.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?\"}]},{\"@type\":\"Person\",\"@id\":\"https:\/\/onlineclassesguru.com\/#\/schema\/person\/1831fa4d28e47b468621cf27932f5742\",\"name\":\"admin_admin\",\"image\":{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/onlineclassesguru.com\/#personlogo\",\"inLanguage\":\"en-US\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/429c8d043f7a770af242b0031e8b9f2b?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/429c8d043f7a770af242b0031e8b9f2b?s=96&d=mm&r=g\",\"caption\":\"admin_admin\"},\"url\":\"https:\/\/onlineclassesguru.com\/index.php\/author\/admin_admin\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM? - onlineclassesguru","description":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/","og_locale":"en_US","og_type":"article","og_title":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM? - onlineclassesguru","og_description":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?","og_url":"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/","og_site_name":"onlineclassesguru","article_published_time":"2021-01-15T06:49:13+00:00","twitter_card":"summary_large_image","twitter_misc":{"Written by":"admin_admin","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebSite","@id":"https:\/\/onlineclassesguru.com\/#website","url":"https:\/\/onlineclassesguru.com\/","name":"onlineclassesguru","description":"Cheap Professional coursework and reaction papers help","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/onlineclassesguru.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"WebPage","@id":"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/#webpage","url":"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/","name":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM? - onlineclassesguru","isPartOf":{"@id":"https:\/\/onlineclassesguru.com\/#website"},"datePublished":"2021-01-15T06:49:13+00:00","dateModified":"2021-01-15T06:49:13+00:00","author":{"@id":"https:\/\/onlineclassesguru.com\/#\/schema\/person\/1831fa4d28e47b468621cf27932f5742"},"description":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?","breadcrumb":{"@id":"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/onlineclassesguru.com\/index.php\/2021\/01\/15\/what-is-a-false-claim-are-mistakes-and-errors-considered-to-be-fraudulent-behavior-what-is-the-purpose-of-a-compliance-program\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/onlineclassesguru.com\/"},{"@type":"ListItem","position":2,"name":"WHAT IS A FALSE CLAIM? ARE MISTAKES AND ERRORS CONSIDERED TO BE FRAUDULENT BEHAVIOR? WHAT IS THE PURPOSE OF A COMPLIANCE PROGRAM?"}]},{"@type":"Person","@id":"https:\/\/onlineclassesguru.com\/#\/schema\/person\/1831fa4d28e47b468621cf27932f5742","name":"admin_admin","image":{"@type":"ImageObject","@id":"https:\/\/onlineclassesguru.com\/#personlogo","inLanguage":"en-US","url":"https:\/\/secure.gravatar.com\/avatar\/429c8d043f7a770af242b0031e8b9f2b?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/429c8d043f7a770af242b0031e8b9f2b?s=96&d=mm&r=g","caption":"admin_admin"},"url":"https:\/\/onlineclassesguru.com\/index.php\/author\/admin_admin\/"}]}},"_links":{"self":[{"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/posts\/26264"}],"collection":[{"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/comments?post=26264"}],"version-history":[{"count":1,"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/posts\/26264\/revisions"}],"predecessor-version":[{"id":26265,"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/posts\/26264\/revisions\/26265"}],"wp:attachment":[{"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/media?parent=26264"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/categories?post=26264"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/onlineclassesguru.com\/index.php\/wp-json\/wp\/v2\/tags?post=26264"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}