Ethics and compliance is a vast topic in any work environment. This type of training is especially important in the medical field because the best interests of the patients rely on it. Below you will find the top three things medical professionals learn during ethics and compliance training.

– Laws Concerning Health Abuse and Frauds

Fraud and abuse laws is a term used to designate several federal laws and regulations which were enacted as a means to reduce, or preferably prevent altogether, conflicts of interests between providing and receiving monetary remunerations and offering top quality patient care.

Fraud is defined as the making of inaccurate statements or distortion of true facts in order to obtain a gratification, monetary or in any other shape or form, which would not have been received in other conditions. Abuse is the term used to describe making certain actions or practices which lead to unnecessary costs to Medicareor other federal healthcare programs.

The abuse and fraud laws that regulate the US healthcare system are: the Federal Anti-Kickback Statute, the False Claims Act, the Social Security Act, the US Criminal Code, the Stark Law, as well as several federal regulations pertaining to mail and wire fraud. These laws are detailed in most Compliance and Ethics training programs.

– The Federal Anti-Kickback Statute:

Federal Anti-Kickback Statute was introduced with the intent to forbid medical professionals from soliciting or receiving remuneration, money or gifts, in exchange for services, goods, or products covered in full, or only partially, by any federal health care plan (Medicare, Medicaid or the TRICARE programs).

All medical professionals that fail to comply with the Federal Anti-Kickback Statute are subject to severe fines and even felony convictions, which may lead to imprisonment and exclusion from the federal program. However, in order to convict a medical professional under this law, bad intention on behalf of the physician has to be proven.

Nonetheless, there are certain types of arrangements or transactions which are immune to the Federal Anti-Kickback Statute and that cannot be prosecuted for violation. In order to be legal, these arrangements have to comply with criteria included in the Safe Harbor legislation.

– The Stark Law:

The Stark Law, also referred to as the doctor of medicine Self-Referral Law, forbids medical professionals from referring federal healthcare program beneficiaries with whom the physicians has any sort of financial ties. The law also applies if the physician’s immediate family (spouse, parents, offspring) have financial relationships with the referred beneficiary. Failing to comply with this law can lead to monetary penalties and, unlike the Federal Anti-kickback Statute, there is no need to prove the physician’s bad intention. Any conviction under the Stark Law will result in the immediate exclusion from any federal healthcare program.

Though Compliance and Ethics training programs deal with several other issues, the three topics presented above are the most important lessons medical professionals should learn when attending this course. Since there are numerous legal consequences that derive from not complying with federal legislations, it is important for any medical professional to attend Compliance and Ethics training.

For more information, please visit our Compliance and Ethics Training website.

For more information, please visit our Compliance and Ethics Training website http://www.hipaaexams.com/compliance-and-ethics-training.html

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Category: Education
Keywords: Compliance and Ethics Training