Best Practices for Reducing Health Care Fraud Risk

Programs and Resources
​​HealthCap® and the American Health Care Association are hosting a free webinar on Tuesday, August 24 at 2 p.m. EDT highlighting best practices for reducing risks related to federal health care fraud oversight and will provide the latest information about enforcement actions that impact skilled nursing facility providers on the regulatory, civil and criminal levels. The one-hour session is titled Health Care Fraud: Utilize Best Practices to Reduce Your Risk. ​

Shortly after CMS announced its most significant recoupment of improperly reimbursed Medicare funds ever on May 17, 2021, several of the most influential federal enforcement agencies announced a collaborative plan to reduce the prevalence of and exercise a broad range of enforcement authority for provider violations involving healthcare fraud. The “Medicare Fraud Strike Force” and “Operation CARE” have been operationalized with staff affiliated with the U.S. Attorney General, Office of Inspector General, Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of Civil Rights and the Department of Justice.

Several federal investigative patterns and targeting methodologies can be taken away from the most recent healthcare fraud investigations. These takeaways can prove essential for providers in understanding the new risk areas. 

A provider who can demonstrate that it has a history of exercising reasonableness in its utilization of risk reduction procedures can diminish the risk of such an investigation. By appropriately implementing goal-oriented plans and monitoring their effectiveness, providers will be in a much better position should an investigation take place than a similarly situated provider who cannot demonstrate that it adhered to best practices, including official guidance. 

The information provided to members during this session has been aggregated and summarized for utilization by members in at least two advantageous ways, including but not limited to: (1) effective and rationally based prioritization of QAPI and corporate compliance agendas, activities and plans; and (2) substantive development of educational programs for staff and contracted providers with an emphasis on focus areas discussed.
Speakers include Angie Szumlinski, Director of HealthCap’s Risk Management Services; and John Paul Hessburg and Andrea DeLand, attorneys with The Kitch Firm.

Pre-registration for this free webinar is required. This webinar will be recorded for those who are unable to attend on August 24. 

AHCA/NCAL has embraced HealthCap® for more than a decade as a premier provider of liability insurance that is solely dedicated to serving senior care communities. HealthCap® clients have the fewest liability claims in the industry, and HealthCap settles claims for approximately one-half the industry average. One of the reasons HealthCap gets such great results is its focus on quality care as the foundation of good risk management practices and HealthCap’s robust risk management resources​.