Governance, Legal Issues, Medicare & Medicaid (AHM510)



This course describes the formation, types, and structure of healthcare management organizations. Along with the role of healthcare management in government-sponsored programs including Medicare and Medicaid, you’ll learn the overall purpose and direction of healthcare management, the impact of fraud and abuse, and the role of public policy. In addition, the course considers the legal issues surrounding ERISA, pharmacy benefits, and wellness programs.

What You’ll Learn

  • Major factors shaping the environment of the health plan industry
  • How health plans use reorganization, reengineering, and strategic planning to improve performance
  • Key legal issues faced by health plans in a post-reform environment
  • Federal and state regulatory requirements that affect health plans
  • The role of the federal government as a purchaser of healthcare benefits
  • The role of health plans in providing services to both Medicare and Medicaid enrollees
  • How fraud and abuse affect the cost and quality of healthcare
  • How health plans use organizational control systems to build internal structures that meet external demands for accountability

Who Should Take This Course

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, and health plans
  • Consumers and others in related fields who seek expertise in this area


  • $220 AHIP Members
  • $280 Non-members

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Earn a Designation

This course is good towards earning the following Academy for Healthcare Management designation:

Fellow, Academy for Healthcare Management (FAHM®)

Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.

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