By profession
For providers, suppliers, pharmacies, Medicare Advantage and Part D plans and their FDRs: recognize fraud, waste and abuse and report it the right way.
For: Staff of providers, suppliers, pharmacies, Medicare Advantage and Part D plans, and their first-tier, downstream and related entities (FDRs), including billing, coding, pharmacy, call center, front office, clinical and management staff
Learn how the False Claims Act, the Anti-Kickback Statute, the Stark Law, the Civil Monetary Penalties Law and OIG exclusion apply to everyday work, how upcoding, unbundling, cloned notes and billing for services not rendered turn into liability, and what an effective compliance program looks like under 42 CFR 422.503 and 423.504 and OIG's 2023 General Compliance Program Guidance.
It is written for the people who actually see fraud first: billers, coders, pharmacists and technicians, DME and home health staff, call center representatives, front-office teams and managers at providers, suppliers, plans and FDRs. You will practice with a billing scenario, two spot-the-red-flag exercises, a referral dilemma, an exclusion screening decision tree and an SBAR report to compliance.
The course uses current federal enforcement data, including record fiscal year 2025 False Claims Act recoveries and the 2026 National Health Care Fraud Takedown, and gives you three job aids: a red-flag checklist, a concern report template and an exclusion screening log.
What you’ll be able to do Monday morning
8 modules · 32 lessons · about 2 contact hours
Diagram · In practice checklist · 2-question knowledge check
Diagram · In practice checklist · 2-question knowledge check
Diagram · In practice checklist · 2-question knowledge check
Diagram · In practice checklist · 2-question knowledge check
Diagram · In practice checklist · 2-question knowledge check
Diagram · In practice checklist · 2-question knowledge check
Diagram · In practice checklist · 2-question knowledge check
Diagram · In practice checklist · 2-question knowledge check
Try it now, no account needed
A branching scenario from this course. Your choices are not saved.
Practice activities
Job aids you keep
This course awards a certificate of completion for 2 contact hours of instruction. It is not approved or accredited by any licensing board, state agency or continuing education accreditor, and it is not a CMS-issued training. Medicare Advantage organizations and Part D sponsors must provide compliance training at least annually and decide what training they accept from their own staff and from first-tier, downstream and related entities, so check with your employer or the plans you contract with whether this course meets their requirement.
Pathways we may pursue include review by continuing education approvers for billing, coding and pharmacy professions, and arrangements with plans and providers that use the course within their compliance training programs. None of these approvals exists today; the course page will show an approval only after it is granted.
Our full approvals listPlans must provide compliance training at least annually and decide what training they accept from their own staff and contractors. This course covers fraud, waste and abuse in depth and gives a certificate of completion for 2 contact hours, but it is not a CMS-issued course. Check with your employer or the plans you work with before relying on it.
No. It awards a certificate of completion for 2 contact hours of instruction and is not approved or accredited by any licensing board, coding credentialing body or accreditor. If you need credit, check whether your board or credentialing organization accepts courses from providers it has not approved.
Anyone whose work touches Medicare or Medicaid billing, orders, prescriptions or member contact: billers, coders, pharmacy staff, DME and home health staff, call center representatives, front office teams, clinicians and managers at providers, suppliers, plans and their first-tier, downstream and related entities.
It explains federal law in depth and notes where states add their own false claims acts, exclusion lists and Medicaid Fraud Control Units, with examples. It is not a state edition. Your compliance officer can tell you which state requirements apply to your organization.
Plan on about two hours for eight modules, interactive exercises and a final assessment of 23 questions drawn from a larger bank. You need 80 percent to pass. When you pass, you can download a certificate of completion showing the course title, date and 2 contact hours.
No. It teaches you to recognize red flags and report them correctly. Whether conduct is fraud depends on facts and law that compliance staff, attorneys and investigators evaluate. If you are unsure, report the facts to your compliance officer or the OIG Hotline.
This course is general education and training awareness from CE Courses Hub on Medicare fraud, waste and abuse compliance. It is not legal, medical or professional advice and does not replace your employer's policies, your plan contracts, your licensing board's rules, or advice from a qualified attorney or your compliance officer. Completing it earns a certificate of completion for the stated contact hours; it is not approved or accredited by any licensing board, state agency or accreditor unless an approval is shown on the course page. Check with your board, employer or state agency whether this course meets your specific requirement.