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Publication (Hardcopy)

Fraud and Abuse

Credit(s): 4 AMA PRA Category 1 Credits™ (Enduring)
Course Number: PME-FRDPUB/GEN
Original Program Date: August 6, 2012
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    Is your practice protected from fraud? Are you sure that you are coding properly? This guide will go into detail on the laws and penalties associated with health care fraud and abuse. It will also equip you with information on Medicare and Medicaid and proper coding techniques.


    Upon reading this publication, you will also be able to identify and implement an appropriate compliance plan that ensures adherence to the laws, regulations, and guidelines that control business activities in solo and small-group practices.


    Released:     Aug. 6, 2012
    Expires:        Aug. 6, 2015


    Target Audience
    This program has been developed for physicians in all specialties.

    Course Objectives
    Upon completion of this course, physicians should be able to:


    1. Explain the definition, history, laws, and penalties associated with health care fraud and abuse;

    2. Discuss fraud and abuse detection and education efforts employed by the Medicare and Medicaid

        programs; and

    3. Identify and implement an appropriate compliance plan/program that ensures adherence to the laws,

        regulations, and guidelines that control business activities in solo and small-group practices.


    Teaching Methods
    The participant is required to read the course in its entirety and complete an online test and course evaluation to obtain credit.

    Sponsored By

    4 AMA PRA Category 1 Credits™ (Enduring)   The Texas Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    The Texas Medical Association designates this enduring activity for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The Texas Medical Association requires physician to complete 70-percent of the test questions correctly to receive credit for this course.

    See TMA’s Web Site Privacy Statement

    4 ETHICS   This course has been designated for 4 credit(s) of education in medical ethics and/or professional responsibility.

    3 TMLT   Physicians who are insured with Texas Medical Liability Trust (TMLT) may earn professional liability insurance discounts by participating in approved continuing education activities. TMLT policyholders who earn 3 TMLT credits within 12 consecutive months will earn a 3-percent discount (not to exceed $1,000), which will be applied to their next eligible policy period.

    DescriptionPagesFile Size
    Table of ContentsNANA
    I will make sure the patient states the chief complaint to the medical assistant and that it is the same thing patient tells me when I walk in the room. - Jose (Pearsall, TX)
    specific information about supervision of trainees and mid-level providers, in re: how to avoid charges of fraud - Amy (Dallas, TX)
    - Rachele (Houston, TX)
    I will be careful in my coding and billing practices and make sure they are as accurate as possible. I found the info on types of reviews most interesting. No other recommendations for course improvement or other courses. - Victor (Mesquite, TX)
    - Jack (, )
    - Malcolm (College Station, TX)
    - Michael (Dallas, TX)
    I will establish a compliance program. How to establish and maintain a compliance program was helpful. - William (Ketchikan, AK)
    Better documentation, formation of a compliance program - Sidney (Dallas, TX)
    More on what to do if audited would be helpful. Will keep working to document reason and plan for a patient's visit. - Jay (Dallas, TX)
    - Rosanna (Spartanburg, SC)
    - Gary (GEORETOWN, TX)
    7. Designate a compliance officer in the practice. 8. The different federal agenencies and regulatory laws. 10. More on EHR - Garry (Sugar Land, TX)
    - Jack (, )
    - Shahnaz (Canutillo, TX)
    Valuable information for the daily practice - Awilda (New Braunfels, TX)
    - Marwan (Garland, TX)
    - Louis (Austin, TX)
    I will designate a compliance officer and schedule internal audits; plan to get myself certified for obgyn coding and compliance - Genoveva (Austin, TX)
    - Robert (, )
    More complete documentation. I learned the mechanism of the RAC which i did not know before. No need to improve just periodically update and let us know when you do so we can read the new information. - William (Austin, TX)
    - Jason (Waco, TX)
    - Erik (Alice, TX)
    - Bryan (, )
    Will institute audits of physician charges. - Leslie (Houston, TX)
    Document more. Explanation of the different types of audits. make this course a little shorter. ICD-10 - Franz (Alice, TX)
    - Syed (Brownsville, TX)
    Start compliance program - William (Alice, TX)
    I will make sure to be thorough in my documentation of each encounter and the rationale for my diagnosis. - Ramona D (Alice, TX)
    no suggestions for improvement. I will continue my current practice in billing and coding. - Bradley (, )
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