RISK 133

Course overview

Hour 1 *Identify various types of billing irregularities and impact on healthcare expenditures. *Distinguish upcoding from bundling within the context of irregular billing schemes. *Demonstrate how and when exceeding a state's scope of practice becomes "the unauthorized practice of medicine". *Explain the restrictions states' scopes of practice place on healthcare providers' authority to treat and diagnose patients. *Discuss how invoicing unrendered medical services impacts third-party payers. *Interpret chiropractic boards' positions on testimonial advertising and how best to comply. Hour 2 *Identify what constitute a false claim under the False Claims Act. *Discriminate a kickback from a self-referral. *Trace how anti-kickback legislation arose and examine its prohibitions. *Explain the enactment of Stark legislation arising on the heels of anti-kickback bans. *Assess providing nutritional counsel within the context of "the practice of medicine". *Evaluate identity theft and its impact on patients, providers and the cost of healthcare. *Discriminate between illegal copayment waivers from proper hardship waivers. *Discuss court cases instancing successful prosecution of healthcare fraud.