Knowlingly carrying out, or planning to carry out, fraud against any healthcare benefit program (Medicare or Medicaid) Overusing services that result in unnecessary costs to the Medicare and Medicaid Programs Carrying out actions that may cause unnecessary costs to the Medicare and Medicaid Programs Fraud Waste Abuse COMPLIANCE WITH CONE HEALTH EMPLOYEE WELCOME GUIDE 11 If you are aware of or see a potential conflict of interest, please call the Compliance and Privacy Helpline at 855-809-3042 or report online at www.conehealth. Please read Cone Health’s Conflict of Interest Policy. I further understand that as a Cone Health employee I have a duty to disclose actual or potential conflicts as a condition of my employment by calling the Compliance and Privacy Helpline at 855-809-3042 or report online at Please review the Conflict of Interest policy via the link below. https:/ / integrity/ Fraud, Waste and Abuse What is fraud, waste and abuse? What is the difference between fraud and waste/abuse? Fraud Fraud requires the person to have the goal (intent) to get payment and the knowledge that his-her actions are wrong. vs. Waste/Abuse Waste/abuse may result in an improper payment, but does not require intent and knowledge. What are potential consequences of fraud, waste and abuse? Federal and state laws and regulations and Cone Health policies and procedures help prevent and detect potential fraud, waste and abuse. In addition to fines and criminal penalties, fraud or noncompliance has consequences for Cone Health and affiliates, including: • Loss of provider licensure. • Exclusion from participation in federal health care programs. • Damage to reputation. • Possible jail time. Identifying and Reporting False Claims A false claim is a fraudulent request for money. Two examples include: • Billing Medicare for services a patient never received. • Upcoding procedures to obtain higher reimbursement. It is against the law for a healthcare provider to submit fraudulent or false claims for payment to programs that are funded by federal or state governments, such as Medicare and Medicaid. Under the Federal False Claims Act, individuals who knowingly submit false claims for payment by the U.S. government are subject to fines and penalties. North Carolina also has a False Claims Act. Cone Health employees are required to report known or suspected false claims immediately. Employees who report are protected from retribution/retaliation by Cone Health policy. A person (whistleblower) who suspects a false claim may file a lawsuit on behalf of the government and potentially receive a reward for bringing original information to the government’s attention.