How to Profit by Preventing Healthcare Fraud

Make Money by Doing The Right Thing...
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  • Lectures 14
  • Contents Video: 1 hour
    Other: 7 mins
  • Skill Level Beginner Level
  • Languages English
  • Includes Lifetime access
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About This Course

Published 12/2014 English

Course Description

Although this course focuses on healthcare fraud, the principals are applicable to anyone who suspects, or is aware of, fraud against the U.S. government.

The course covers:

  • What is fraud? What are examples of healthcare fraud?
  • The scope of healthcare fraud and the threat it poses to Americans.
  • Why the government needs the help of "insiders" in fighting fraud.
  • The legal concepts that allow citizens to be financially rewarded for helping the government fight fraud.
  • What to expect as a "whistle-blower."
  • Selecting an appropriate attorney
  • Examples of whistle-blower financial awards
  • Reality Check: The downside of deciding to blow the whistle

What are the requirements?

  • Students will need audio and video capability, as well as Internet access. to participate in this unique learning experience.

What am I going to get from this course?

  • Determine if they have a potential qui tam lawsuit against a suspected fraudulent healthcare provider
  • Understand the nature and diversity of fraud and be able to recognize it in the workplace
  • Articulate what a qui tam lawyer will need, and what will be required to convince the U.S. government to join her case
  • Accept the "downside" of becoming a "whistleblower" and determine if this is a correct course of action for your particular situation

What is the target audience?

  • Employees engaged in any form or healthcare. This includes hospitals, physician practices, manufacturers, vendors, consultants, coding specialists, office managers, receptionists, nurses, medical assistants, security officer, risk management specialists, physicians, and healthcare consumers
  • The concepts covered in this course are focused on healthcare fraud. However, the general principals are relevant to any employee, in any industry, that does business with the government and suspects fraud.

What you get with this course?

Not for you? No problem.
30 day money back guarantee.

Forever yours.
Lifetime access.

Learn on the go.
Desktop, iOS and Android.

Get rewarded.
Certificate of completion.

Curriculum

Section 1: Healthcare Fraud: The 800 lb. Gorilla...
01:19

The instructor welcomes you to the course. Although this program focuses on healthcare fraud, the principles pertain to anyone and any industry that does business with the government. The course will cover:

  • Fraud defined
  • The scope of healthcare fraud in America
  • The legal foundations that let you report and financially benefit by reporting fraud
  • Common types of healthcare fraud schemes
  • The realities and risks of becoming a "whistleblower"

The course provides several quizzes that will assess your understanding of the material.

05:18

In this lecture we look at the scope and variety of various healthcare schemes. After this section you understand how this illegal activity undermines the nation's economy and the health of our citizens. Please don't forget to read the piece from The Economist which is included with the supplemental resources.

08:00

After this lesson you will be able to determine if fraud is being conducted in your workplace. The required elements of fraud are described. You will be able to evaluate potential situations and determine whether you are witnessing inefficiency and incompetence-- or criminal fraud. You will also be able to differentiate the key differences between criminal and civil law.

10 questions

These questions check for understanding of fraud and how it is defined under the law.

07:57

After this lecture, you will understand that most healthcare providers are honest. However, you will also have a better understanding of how some of these schemes are devised. Specifically:

  • Be sensitive to the opportunities your workplace may provide to dishonest individuals.
  • Be observant for things that simply "don't seem right."

As always, spend time with the supplemental resources included with most lectures. They amplify and enhance your learning experience.

3 questions

A review of the most common scams in healthcare.

7 pages

This is a self-guided exercise. It is basically a slide show of recent cases of note.There is no audio or video. Please read and work your way through the slides. Upon completion of this section you should build on previous information regarding the nature of today's healthcare environment. For example:

  • Omnicare, Inc. is the nations's largest pharmaceutical and pharmacy services provider to nursing homes. The company agreed to pay $124 million to resolve charges it violated several federal laws by providing improper financial incentives to nursing homes in order to retain their business.
  • These "incentives" were funded by the American taxpayer via Medicare/Medicaid.
  • The person that "blew the whistle," was former employee Donald Gale. He will receive about $17 million out of the government's recovery.

As always, I encourage you to spend time with the additional resources accompanying these lectures.

Of particular interests will be the 2010 60 Minutes broadcast about "whistleblower" Cheryl Eckard and her issues with pharmaceutical giant Glaxco and its subsidiaries. She and her attorneys sued for providing unsafe and diluted drugs to federal health programs. Her "bounty" was in the neighborhood of $96 million.

60 Minutes- "Bad Medicine"

Section 2: Legal Aspects
02:32

You are introduced to the legal concept of qui tam. It means "he who sues for himself as well as the king." You will learn how this concept developed over the centuries. You will be able to articulate the implications qui tam has for the prevention of healthcare fraud.

Supplemental materials include an annotated Congressional Research Service report that amplifies the material from the main lecture.

10:24

Here you will learn about the history and evolution of the False Claims Act (FCA). As the primary tool used for fighting fraud against the government, it provides private attorneys a financial incentive to use their own resources to pursue fraudulent operators on behalf of the government.

You will also understand why this legislation is often referred to as the "Whistleblower Law."



05:35

In this case we analyze a successful qui tam lawsuit. This example will illustrate the nature of evidence needed to successfully prevail in a case. You will also understand why such lawsuits can take so much time to resolve and realities of being harassed once you are identified as a "whistleblower."

05:47

Here we will continue the analysis of our case study (Extendicare). By the end of this lecture you will understand how their fraud was committed, how the preliminary complaint was constructed, and the importance of a detailed, accurate, building block approach to making your case.

2 questions

A review of the U.S. and Tracy Lovvorn vs. Extendicare

Section 3: The False Claims Act and Employee Protections
08:16

In this section you will learn about the legal protections provided to so-called "whistleblowers." It is important to note that these protections are not proactive. Section H of the False Claims Act is discussed. This is the primary legal mechanism for defending you against harassment or termination.

06:56

You will learn of the crucial importance of confidentiality when dealing with your attorney. The importance of the "race to the court house," and how contingency agreements are generally arranged. The types of information your attorney will request is also covered.

00:36

The "lecture" basically consists of two YouTube links to law firms. These attorneys do a fine job of explaining what has to happen in order to succeed with your qui tam claim. Your work will be key in gathering the information needed. The quantity and quality of the information you provide will be a key factor is the government's decision to join or decline your case.

01:45

Here you will understand the importance of knowing what you are getting into should you decide to report healthcare fraud. It can take an emotional and economic toll. You can expect retaliation once you are identified as a whistleblower. Depression, nightmares and alcohol abuse are often part of the package. Several external sources are provided that discuss the downside of having the courage to "do the right thing..."

Course Conclusion
02:44

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Instructor Biography

Cole Morris, Board Certified in Security Management

Over 30 years experience as a security professional. I have served in a diverse array of environments, including military, Fortune 500 high-technology, homeland security, and most recently, as the director of security for a major hospital network.

I have taught graduate-level security management as an adjunct faculty member of Webster University. I served 20 years in the United States Air Force in a number of capacities, including security, intelligence, and air operations. I have also served as a logistics advisor to two foreign governments (Canada and the Republic of Singapore)

Internationally published, my work has appeared in a wide-array of trade and professional periodicals, including Security Management, Police, and Airpower Journal.

Education includes a BA (summa cum laude) in Criminal Justice from Rowan University and a Masters of Public Administration (MPA) from Troy State University.

I am board certified in security management and hold the Certified Protection Professional (CPP) credential under the auspices of the American Society for Industrial Security (ASIS, International)

Additionally, I maintain the credential of Certified Healthcare Protection Administrator (CHPA) under the auspices of the International Foundation for Healthcare Security and Safety (IAHSS).

Finally, I am the author of Udemy's free course, How to Succeed in your Security Career, which is currently nearing 1,500 global students.

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