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IHP 630 Module Eight Activity Fraud, Waste, and Abuse Reduction Memo Guidelines and Rubric

Overview

In this module, you explored the importance of documentation in government compliance and reporting. When assisted by technology, documentation becomes easier to capture and maintain,

as well as less prone to errors, which in turn improves the patient experience.

This activity will help you describe how technology supports regulatory compliance in healthcare. It also enables you to explain how regulation, fraud, and abuse impact operations and patient

care.

Scenario

You work within a healthcare organization as the director of quality, and your chief compliance of�cer has asked you to create a memo to be distributed to the entire organization. They have

asked that the memo focus on how an organization can better manage risk to the revenue cycle and healthcare reimbursement by examining ways to reduce fraud, waste, and abuse.

Directions

Create a memo to assess how the following laws and regulations can help a healthcare organization reduce fraud, waste, and abuse and thereby manage risk to the revenue cycle and

reimbursement. Also, recommend strategies and technology to help an organization abide by the laws and regulations. Refer to the following laws and regulations to guide your response:

False Claims Act

Physician Self-Referral Law

Anti-Kickback Statute

Anti-Trust Laws

You may refer to the “Activity Reading” resource in the module resources section to better understand how a memo is structured. If you need writing support, access the Online Writing Center

through the Academic Support module of your course.

Speci�cally, you must address the following rubric criteria:

1. False Claims Act: Analyze the impact of the False Claims Act on the organization’s reimbursement, coding, and strategic planning. Consider the following questions to guide your

response:

What are the provisions of the False Claims Act?

What penalties could an organization face for violating the Act?

2. Physician Self-Referral Law: Analyze the impact of the Physician Self-Referral Law on a healthcare organization’s reimbursement, revenue cycle, and strategic planning. Consider the

following questions to guide your response:

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What are the features of the Physician Self-Referral Law?

How does this law help prevent fraud and abuse in healthcare?

3. Anti-Kickback Statute: Analyze the impact of the Anti-Kickback Statute on healthcare reimbursement and referrals. Consider the following questions to guide your response:

How is the Anti-Kickback Statute different from the Physician Self-Referral Law?

What kind of �nancial penalties would be attracted by the violation of this statute?

4. Anti-Trust Laws: Analyze the impact of the Anti-Trust Laws on a healthcare organization’s �nancial performance and strategic planning. Consider the following questions to guide your

response:

What are the premises of the Anti-Trust Laws?

How do the Anti-Trust Laws help prevent fraud and abuse in healthcare?

5. Recommendations: Recommend strategies and technology to reduce operational risk and promote operational ef�ciencies by integrating the regulations that prevent fraud, waste, and

abuse. Consider the following questions to guide your response:

What measures can you take to incorporate the provisions of the False Claims Act and the Anti-Trust Laws?

What process changes will help the organization comply more easily with the Physician Self-Referral Law and the Anti-Kickback Statute?

All the claims in your deliverable should be evidence based. Your citations should be from your independent search for evidence (not from the textbook or module resources) of credible

sources and be current within the last �ve years. You are required to cite a minimum of two sources, at least one of which should be separate from your own research. Refer to the IHP 630

Library Guide located in the Start Here section of the course for additional support.

What to Submit

Submit your memo as a 3- to 4-page Microsoft Word document with double spacing, 12-point Times New Roman font, and one-inch margins. Also include a title page. Sources should be cited

according to APA style.

Module Eight Activity Fraud, Waste, and Abuse Reduction Memo Rubric

Criteria Exemplary (100%) Pro�cient (90%) Needs Improvement (70%) Not Evident (0%) Value

False Claims Act Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the impact of the

False Claims Act on a

healthcare organization’s

reimbursement, coding, and

strategic planning

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

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Criteria Exemplary (100%) Pro�cient (90%) Needs Improvement (70%) Not Evident (0%) Value

Physician Self-Referral Law Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the impact of the

Physician Self-Referral Law on

a healthcare organization’s

reimbursement, revenue cycle,

and strategic planning

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Anti-Kickback Statute Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the impact of the

Anti-Kickback Statute on

healthcare reimbursement and

referrals

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Anti-Trust Laws Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Analyzes the impact of the

Anti-Trust Laws on a healthcare

organization’s �nancial

performance and strategic

planning

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Recommendations Exceeds pro�ciency in an

exceptionally clear and

insightful manner, using

industry-speci�c language

Recommends strategies and

technology to reduce

operational risk and promote

operational ef�ciencies by

integrating the regulations that

prevent fraud, waste, and abuse

Shows progress toward

pro�ciency, but with errors or

omissions

Does not attempt criterion 15

Articulation of Response Exceeds pro�ciency in an

exceptionally clear and

insightful manner

Clearly conveys meaning with

correct grammar, sentence

structure, and spelling,

demonstrating an

understanding of audience and

purpose

Shows progress toward

pro�ciency, but with errors in

grammar, sentence structure,

and spelling, negatively

impacting readability

Submission has critical errors in

grammar, sentence structure,

and spelling, preventing

understanding of ideas

10

Scholarly and Professional

Sources

Incorporates more than two

scholarly, current (within the

last �ve years) sources, or use

of sources is exceptionally

insightful

Incorporates two scholarly,

current (within the last �ve

years) sources that support

claims

Incorporates fewer than two

scholarly, current (within the

last �ve years) sources, or not

all sources support claims

Does not incorporate sources 10

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Criteria Exemplary (100%) Pro�cient (90%) Needs Improvement (70%) Not Evident (0%) Value

APA Style Formats in-text citations and

reference list according to APA

style with no errors

Formats in-text citations and

reference list according to APA

style with fewer than �ve

errors

Formats in-text citations and

reference list according to APA

style with �ve or more errors

Does not format in-text

citations and reference list

according to APA style

5

Total: 100%

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