Course Code: REL-ACU-0-HFWYNK
Hours: 1
Type: Online Course
Content Expiration Date: 12/31/2026
Learning Objectives:
Define healthcare fraud and the problems identified with fraud control.
Recall key federal laws that are used to investigate and prosecute healthcare fraud.
Identify the clinician’s role in recognizing, avoiding, and reporting healthcare fraud.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Defining Healthcare Fraud
What is Healthcare Fraud?
Terminology
How is Healthcare Fraud Committed?
Fraud Detection Initiatives
Laws Governing Healthcare Fraud
Section 3: Prosecution and Investigation for Violators
Anti-Kickback Statute
Physician Self-Referral Law
False Claims Act
Civil Monetary Penalties
Exclusion Statute
Section 4: Avoiding Healthcare Fraud
Telemedicine
Clinician’s Role
Section 5: Reporting
What is a Whistleblower?
Why Report?
How to Report?
Whistleblower Best Practices
Additional Resources
Section 6: Clinical Vignette
Case Study
Section 7: Conclusion
Course Summary
Course Contributors
Resources
References
Subject Matter Expert: Laura L. Morgan, MSN, RN, NEA-BC
Laura L. Morgan, MSN, RN, CCRP, NEA-BC, currently serves as the Clinical Education Specialist at Lincoln County Medical Center in Ruidoso, New Mexico. She plans, develops, implements, and evaluates educational programs for clinicians, using the most current research and clinical data, while fostering the implementation of evidence-based practice. Ms Morgan is an endorsed member of the Society of Clinical Research Associates, member of Sigma Theta Tau international honors Society of nursing, an instructor for Basic Life Support, Advance Cardiovascular Life support and a Board Certified Nurse Executive-Advanced from the American Nurses Credentialing Center.
Instructor: Brandy Verton, BSN, RN, CNOR
Brandy earned a Bachelor of Science in Nursing degree with summa cum laude distinction from Capella University. She is a certified perioperative nurse with versatile skills in circulator and scrub roles for different surgical specialties. Brandy has fulfilled several nursing leadership responsibilities as the Surgical Services Clinical Educator and Periop 101 instructor for UNC REX Healthcare in North Carolina. She has been an active member of various hospital committees and contributed to numerous process improvement initiatives. In the early stages of her career, she developed her core nursing skills while working on a postoperative and medical-surgical overflow unit. She served in various roles, including charge nurse, preceptor, Magnet Champion, and admission/discharge facilitator. Brandy is dedicated to elevating perioperative teams through evidence-based education, innovative training, and collaboration, ensuring safe surgical care and continuous professional growth.
Target Audience:
The target audience for this course is: Medical Assistants; Medical Providers; Nursing Personnel; in the following settings: Hospitals: Acute.
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.
All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.