Hour 1

• Identify various types of billing irregularities and impact on healthcare expenditures.
• Distinguish upcoding from bundling within the context of irregular billing schemes.
• Demonstrate how and when exceeding a state’s scope of practice becomes “the unauthorized practice of medicine.”
• Explain the restrictions states’ scopes of practice place on healthcare providers’ authority to treat and diagnose patients.
• Discuss how invoicing unrendered medical services impacts third-party payers.
• Interpret chiropractic boards’ positions on testimonial advertising and how best to comply.

Hour 2

• Identify what constitute a false claim under the False Claims Act.
• Discriminate a kickback from a self-referral.
• Trace how anti-kickback legislation arose and examine its prohibitions.
• Explain the enactment of Stark legislation arising on the heels of anti-kickback bans.
• Assess providing nutritional counsel within the context of “the practice of medicine.”
• Evaluate identity theft and its impact on patients, providers and the cost of healthcare.
• Discriminate between illegal copayment waivers from proper hardship waivers.
• Discuss court cases instancing successful prosecution of healthcare fraud.