[3108] Fraud, Abuse & Ethics
Provides a general overview of healthcare fraud & abuse laws with a practical understanding of how they work.
Presentation Info:
- Presentation Date: November 14, 2017
- TAHC&H Event: HCSSA Administrator Program | Houston
Subscription Type: Individual
Education-Training Credits:
- TX HCSSA Administrator/Alternate Continuing Education
- Social Worker
CE Approval Statements:
· This program meets continuing education requirements
for Administrators and Alternates under Texas HCSSA licensing regulations.
· Texas Association for Home Care & Hospice is an approved provider of social work education by the Texas State Board of Social Work Examiners, approved provider #1230.
HCSSA Topic(s) Addressed:
- §97.259[d][1]information regarding fraud and abuse detection and prevention
- §97.259[d][4]agency responsibilities
- §97.260[a][6]risk assessment and management
Program Description: Medicare certified home health agencies,
private duty agencies and hospices are looking for ways to collaborate with other providers, including
referral sources. While collaboration may address some difficult problems, the statute and rules regarding
fraud and abuse still apply to all provider types. This program provides a general overview of
healthcare fraud & abuse laws that affect providers including:
- False Claims Act
- Stark & Anti-Kickback Statutes
Statistics, investigations, and unethical conduct (including blatant overutilization) is discussed.
The program also provides a fundamental understanding of these laws to Home Care
administrators using real-life home care examples. These case studies include a range of situations in marketing,
delivery of care, and referral arrangements. By discussing these laws in context of common scenarios, this presentation
provides a practical understanding of how they work.
Program Learning Outcome:
- Learners will actively engage in the activity and indicate an intent to change or
enhance their practice by ensuring application of fraud and abuse surveillance within their agency to promote ethical standards of practice.
TAHC&H Faculty/Presenter: William Dombi, JD, President, National Association for Home Care & Hospice
About the Presenter:
William Dombi, JD is the President of the
National Association for Home Care & Hospice. Bill specializes in legal, legislative, and regulatory advocacy on behalf of
patients and providers of home health and hospice care. With nearly 40 years of experience in health care law and policy,
he has been involved in virtually all legislative and regulatory efforts affecting home care and hospice since 1975,
including the expansion of the Medicare home health benefit in 1980, the formation of the hospice benefit in 1983, the
institution on Medicare PPS for home health in 2000, and the national health care reform legislation in 2010. With
litigation, Dombi was lead counsel in the landmark lawsuit that reformed the Medicare home health services benefit,
challenges to HMO home care cutbacks for high-tech home care patients, lawsuits against Medicaid programs for inadequate
payment rates, along with current lawsuits challenging the Medicare home health face-to-face encounter rule and the
Department of labor changes to the overtime rules under the Fair labor Standards Act.
In addition to litigation, Bill offers extensive community and professional educational services through lectures,
publications, teleconferences, and videos. He is the Editor and lead author of Home Care & Hospice Law: A Handbook for
Executives, the only comprehensive legal treatise on the topic. His lectures include market trends in home care,
compliance, risk management, patient rights, fraud and abuse, health care reimbursement, legislative and regulatory
reforms, and legal issues in telehealth services.
[3108] Fraud, Abuse & Ethics
