– Billing – Quality – Reporting – Credentialing – Governance – Compliance process WHAT IS FRAUD • • • • • • • • • • • – “Fraud” is intentional breach of the standard of good faith and fair dealing, as understood in the community, involving deception or breach of trust, for money (USA v. Goldblatt) – In health care practice, “fraud and abuse” has come to includes far more than the Goldblatt definition-kickbacks and Stark violations – Health care fraud, mail fraud, false statements and instruments…
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