Fraud and Abuse, & Compliance Worksheet

Module 8:  Fraud and Abuse, & Compliance Worksheet 

After completing the required reading, complete the following tables with the required information.

Part I:  Total points available – 15 points

Fraud and Abuse, & Compliance Glossary

Term Definition

Fraud and abuse  

Upcoding  

Unbundling  

False Claim Act (FCA)  

Whistle-blowers  

Anti-kickback statute  

American Recovery and Reinvestment Act of 2009 (ARRA) (as it applies to health care fraud and abuse)

Strengthens the HIPAA regulations.  (page 332)

Specifically states that business associates are covered by the HIPAA Security Rule. 

Clarifies who can be held accountable for wrongful disclosure of protected health information. 

Addresses noncompliance due to willful neglect. 

Addresses the civil money penalty provisions of HIPAA, the restitution provided to the government due to health care fraud and abuse may be used to fund HHS’s enforcement activity. 

Office of Inspector General (OIG)  

Correct Coding Initiative (CCI)  

Payment Error and Prevention Program (PEPP)  

Defense Criminal Investigative Service (DCIS)  

Compliance  

Compliance Program  

Corporate Integrity Agreements (CIA)  

Red Flag Rules  

Part II:  Note the seven (7) guidelines for a compliance program:

  Compliance Program Guidelines

1  

2  

3  

4  

5  

6  

7