Write a workplace brief (5-7 SINGLE SPACED pages) of evidence-based recommendations to identify and address upcoding, an incorrect health care billing practice. Include a description of the major categories of health care fraud and abuse and the laws designed to address them.

SCORING GUIDE MUST BE FOLLOWED TO THE LETTER

APA Format

Resources:

This website contains valuable information regarding basic compliance concepts, terminology, explanations of laws, and additional important resources for the workplace. Laws covered include: the Federal False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Law, the Criminal Health Care Fraud Statute, the Exclusion Statute, and the Civil Monetary Penalties Law:

• €‹Centers for Medicare and Medicaid Services. (2017). Avoiding medicare fraud and abuse: A roadmap for physicians. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicar…

This important website contains provider compliance program guidance, a rationale for the importance of compliance, program effectiveness measurement resources, training materials, and more. This site also provides some excellent videos, such as examples of the 2017 fraud report “take downs,” including $1.3 billion in billing fraud and $4 billion dollars in total fraud:

• €‹United States Department of Health and Human Services, and Office of the Inspector General. (n.d.). Compliance education materials: Compliance 101. Retrieved from https://oig.hhs.gov/compliance/101/

This government website contains examples of actual compliance incidents and the resulting corporate integrity agreement documents. You may wish to search for agreements in a specific region or state nearest you:

• United States Department of Health and Human Services, and Office of Inspector General (2018). Corporate integrity agreement documents. Retrieved from https://oig.hhs.gov/compliance/corporate-integrity…

‹This resource explains the anti-kickback law:

• United States Government Publishing Office. (n.d.) Title 42—The public health and welfare [Anti-kickback statute]. Retrieved from https://www.gpo.gov/fdsys/pkg/USCODE-2016-title42/…

This resource explains the criminal health care fraud statute:

• United States Government Publishing Office. (n.d.) Title 18—Crimes and criminal procedure [Criminal health care fraud statute]. Retrieved from https://www.gpo.gov/fdsys/pkg/USCODE-2016-title18/…

This resource explains the false claims act:

• United States Government Publishing Office. (n.d.) Title 31—Money and finance [False claims act]. Retrieved from https://www.gpo.gov/fdsys/pkg/USCODE-2016-title31/…

This resource explains a law dealing with physician self-referral:

• United States Government Publishing Office. (n.d.) Title 42—The public health and welfare [Physician Self-Referral or Stark Law]. Retrieved from https://www.gpo.gov/fdsys/pkg/USCODE-2016-title42/…

This resource explains the exclusions statute for participation in federally funded operations:

• United States Government Publishing Office. (n.d.) Title 42—The public health and welfare.[Exclusion statute]. Retrieved from https://www.gpo.gov/fdsys/pkg/USCODE-2016-title42/…

This reading explains the civil monetary penalties law:

• United States Government Publishing Office. (n.d.) Title 42—The public health and welfare [Civil monetary penalties law]. Retrieved from https://www.gpo.gov/fdsys/pkg/USCODE-2016-title42/…

The following video contains critical information about how to protect yourself from health care fraud and abuse in the workplace. It also tells you what to do if you suspect a violation:

• United States Department of Health and Human Services, and Office of Inspector General. (n.d.). Reporting Fraud to OIG. Retrieved from