CHAPTER 5: Compliance, Fraud, and Abuse

Laurie A. Rinehart-Thompson, JD, RHIA, CHP, FAHIMA

Learning Objectives

After completing this chapter, the reader should be able to:

  • Discuss the laws and penalties concerning fraud and abuse in health care.

  • Identify the responsibilities and liabilities of the health information management (HIM) professional relative to those laws.

  • Identify roles of the HIM professional in establishing compliance programs and meeting the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).


The health information management (HIM) professional is a key player in the process that begins with the delivery of care to a patient and leads to the submission of a bill ...

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