Preventing Fraud, Abuse, and Waste: A Primer for Physical Therapists
-
Register
- Non-Member - Free!
- PT Member - Free!
- PTA Member - Free!
- Student - Free!
- Post-Professional Student - Free!
- Staff - Free!
The federal government and other payers have enacted laws, written regulations, and introduced policies to crack down on the prevalence of health care fraud, abuse, and waste. While the vast majority of physical therapists provide patients with appropriate services and submit proper claims for payment with accurate information, the payment system and regulatory environment is complex and lack of knowledge can put therapists at risk for billing errors that could be considered fraud, waste, or abuse. This self-directed reading course explains the difference between fraud, waste, and abuse and provides the information necessary to comply with relevant laws and regulations that affect payment. Topics covered include laws governing a PTs relationships with payers, referral sources, and patients, evidence-based practice and ethics/professionalism, and the basic elements of a compliance program.
Learning Objectives:
After completing this activity, the learner will:
1. Distinguish between fraud, abuse, and waste
2. Identify the 5 federal fraud and abuse laws important for physical therapists to know
3. Identify inappropriate billing, coding, and documentation practices
4. Identify improper relationships with physicians and other referral sources
5. Recall the 7 core elements that form the basis for developing a compliance program
6. Locate resources to help them take action if there is a problem.
Gayle Lee
JD
Gayle Lee, JD has over 15 years of experience working on health care issues impacting the rehabilitation industry. Currently, Gayle serves as the senior director of Health Finance and Quality for the American Physical Therapy Association (APTA). As the department's Federal payment policy expert, Gayle's key areas of responsibility include Medicare, Medicaid, HIPAA, and health care reform. She specifically works on regulations that impact physical therapists that practice in skilled nursing facilities, home health agencies, rehabilitation hospitals/units, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, and private practice settings. Gayle came to APTA from the American Rehabilitation Association, where she was Assistant Counsel and Policy Coordinator. She worked on issues that affected rehabilitation hospitals/units and CORFs. Gayle received her law degree at the Washington College of Law at the American University in Washington, DC and completed her undergraduate work at Pennsylvania State University located in University Park, Pennsylvania.
Course Instructions
- Click on the Contents tab to watch the course files.
- Click the Take Quiz button to complete the assessment. Learners will have 3 attempts to pass and must answer at least 70% of questions correctly.
- Click Fill Out Survey under the Evaluation listing to provide valuable course feedback. Scroll down on all questions as there may be answer options that expand past the size of the window.
- Click the View/Print Your Certificate button under the Certificate listing. You can view/print your certificate at any time by visiting the APTA Learning Center and clicking the CEU Certificate/Transcript link on the left-hand side of the page.
Need Assistance?
For assistance logging in, accessing activities, claiming credit, or for other questions or concerns, please e-mail learningcenter@apta.org.
Key:
Complete
Next
Failed
Available
Locked