Fraud, Waste & Abuse
What is Fraud, Waste, and Abuse?
Fraud is the intentional misuse of information in order to persuade another to part with something of value or to surrender a legal right. It could also be an act of planned deception or misrepresentation. Waste means to use, consume, spend or expend thoughtlessly or carelessly. Abuse includes providing information or documentation for a health care claim in a manner that improperly uses program resources for personal gain or benefit, yet without enough evidence to prove criminal intent.
What laws are in place to govern Medicare Fraud and Abuse?
- Federal laws governing Medicare fraud and abuse include all the following:
- Federal False Claims Act (FCA)
- Anti-Kickback Statute (AKS)
- Physician Self-Referral Law (Stark Law)
- Social Security Act
- United States Criminal Code 19
Does MUSC have to report FWA noncompliance?
The MUSC Compliance departments employ a variety of processes for reporting noncompliance to appropriate and applicable state and/or federal agencies.
What should you do if you suspect FWA noncompliance?
Employees, agents, and business partners should report any such instances as follows, so that MUSC may investigate, remediate, and report immediately.
Stacey Dodd, MUHA Chief Compliance and Privacy Officer
doddst@musc.edu
843-792-6128
Kellie Mendoza, MUSCP Chief Compliance and Privacy Officer
mendozak@musc.edu
843-792-4693
Angela Wertz, University Director of Compliance
wertza@musc.edu
843-792-9607
Confidential Hotline
1-800-296-0269
MUSC enforces a zero-tolerance policy for retaliation against anyone who reports suspected misconduct.
Confidential Hotline
Available 24 hours a day, 7 days a week
Report any activity reasonably believed in violation of any law or regulation, any MUSC policy, or any Federal or State healthcare requirement by means of our Confidential Hotline at 800-296-0269.
Reports of fraud, waste, abuse, mismanagement, misconduct, or violations of state or federal law may also be made to the South Carolina Office of the State Inspector General (OIG) by calling 1-855-723-7283 (1-855-SCFRAUD) or online through the OIG's website.