Together, We Can Fight Fraud, Waste and Abuse

Fight fraud

The February issue of Humana’s YourPractice is always important. Each year, we pack this issue full of essential information about our annual compliance training requirements, updates to our clinical and pharmacy policies, as well as other articles that can help your practice.

Did you know that every Humana associate has similar compliance training requirements to those we require for your practice? In fact, along with the required fraud, waste and abuse (FWA) training, ethics training and compliance policy, every Humana associate and contractor must complete additional modules on protecting information, cultural competency, health, safety and welfare and more.

We believe in this program because we see the consequences of FWA every day. Even though we can’t put a specific number on the amount lost each year as a result of health care fraud, we know that the dollar amount is in the billions and that this cost comes at the expense of everyone’s health. The Centers for Medicare & Medicaid Services (CMS) note the following effects of FWA*, and I have seen these as well, as both a clinician and medical director:

  • Delayed benefits
  • Difficulty in using providers of choice
  • Hurdles to care
  • Denial of benefits
  • Lower profits
  • Higher premiums
  • Lower benefits for individuals and employers
  • Higher copayments
  • Lower star rating

You play a vital role in the fight against FWA. Please refer to this page to find out how you can complete the required training, which includes instructions about confidentially and anonymously reporting noncompliance.

Sincerely,

Charles Stemple, D.O., MBA Market Vice President, Health Guidance Organization