This is a 2-hour course of instruction that presents the basic elements of professional fraud to make sure doctors do not accidentally commit fraud. If insurance fraud were a single company, it would be a Fortune 100 company. Insurance companies are becoming more vigilant to prevent fraud by initiating civil legal action to recoup fraudulent payments to doctors.
COURSE OBJECTIVES: Learner will be able to
1. Describe basic elements of a fraud case
2. Describe common behaviours that are red flags to insurance carriers.
3. Explain what standards of care are and how these standards change over time
4. Describe appropriate practice methods that reduce the risk of a claim of negligent practice
5. Describe common regulatory complaints against doctors of chiropractic
6. Explain what appropriate practice methods will reduce the risk of regulatory complaints
7. Understand legislative and regulatory control over the practice of chiropractic in New York State
Legal elements of a fraud case – 40 min
Documentation that looks like fraud – 20min
Diagnostic protocols that look like fraud – 20 min
Case management protocols that look like fraud – 20min
Use of consultants and advanced imaging that look like fraud – 20 min