ph;tjvhpbj;ql.cvw>th;xgjug>xgj0jrvd> (ST. ELIZABETH MEDICAL CENTER) cdyehmu&xtw>[h.w>oh.nge>yx>b.c;w>vlrydmrrxgj w>bsx

Size: px
Start display at page:

Download "ph;tjvhpbj;ql.cvw>th;xgjug>xgj0jrvd> (ST. ELIZABETH MEDICAL CENTER) cdyehmu&xtw>[h.w>oh.nge>yx>b.c;w>vlrydmrrxgj w>bsx"

Transcription

1 ph;tjvhpbj;ql.cvw>th;xgjug>xgj0jrvd> (ST. ELIZABETH MEDICAL CENTER) cdyehmu&xtw>[h.w>oh.nge>yx>b.c;w>vlrydmrrxgj w>bsx

2 w>ugj;zk.udm w>vxw>cdyehm w>bsxw>ej.usjph;w>m.rh>w>rekrvj.i e,l,d;ud>pj.w>vlrydmrrxgjw>bsxtw>*h>udwz. w>vlrydmrrxgjw>bsxw>&j.w>usjrt*h>tusdrwz.i w>vlrydmrrxgjw>bsxw>&j.w>usjrtw>m>bsk;wz.i w>ymzsgxd.w>rrwwdwvdr (Qui Tam rhwrh> Whistleblower) t w>od.w>od ysrrrw>zdtrlt'grh>rekrvj.i,-ux;qj;usd;'d;rwrvj.i,vjrrrm>vhmw>vlrydmrrxgjw>bsxw>ej.usjugj;'dwbh.ohvxw>vd>zj vj.i w>o;pjwz.tw>b.*hm*lmi

3 u&xtw>vlrydmrrxgjw>bsxph;w>m.rh>w>rekrvj.i cdyehmu&xtw>vlrydmrrxgjw>bsx (Corporate Compliance) thrrh>0jw>wdmusjrwcgvxtb. w>p;xd.tdrvxzj.'&x.w>ug>pl.u,mt0jr'x; (Federal Office of the Inspector General)<rh>'fod;urRpXR0JySRvXt[h.ql.cVw>uG>xGJwz.zJt0Joh.xH.oh.ngM>w>tD.usd.ph wwdwvdr 'D;w>rRw&Dwygtcg< vxtwdmol.ymo;rr0j rhwrh> wwdmol.ymo;rr0jb.m.vdri cjthre,l,d;ud>pj.'k;td.xd.0jw>vxw>ub.rrtdrb.xgj'd;u&xtw>vlrydmrrxgjw>bsxw>wdmusjr wz.vxysrvxt[h.ql.cvw>ug>xgjvxt'd;m>rj;'h>ch; (Medicaid) phqd.xgj 500<000 'Dv. vxweh.wbsdwz.m.vdri w>rrvh.vdtd.usd.phwwdwvdrm.w>ymzsgxd.tdr'ftrh>w>vh.w>vdwrhrvxw>ymvdro;rrtdr rhwrh> w>ymzsgxd.w>*h>ur.vxysrw*roh.ng0jvxtur.'d;ujxd.0johvxw>[h.usd.phvxwtd.'d;w> ysj[h.pdurdrvxrj;'h>cj (Medicare) rhwrh> rj;'h>ch; (Medicaid) tzdvmwz.m.vdri w>rrwcgvxewrrtdr'd;echph[h.u'gjp&d rhwrh> [h.u'gjp&dvxw>vxysrql;ysrqgwrrm>0jb.wcg t*d>m.vdri ysrvxt[h.vdrw>thrw>chtdrphtd.vd;cdzsd OIG vxtw>chu'gjp&dvxtwwd wvdr< 'D;rh>rRur.0JwbsDw>ChtDRph 5<000 wkr 10<000 'Dv.< vx 1998 eh.w>chvh.vdph urlrur.tw>bsx (1998 False Claim Act) tzdvmm.vdri w>rrw&dwyg tcdyndrh>0jw>ujxd.to;wrhrv>v> rhwrh>< ysr[h.w>rrpxr rhwrh> ysr[h.vdrw> w*rtw>zh;w>rrvxtwb.bsd;b.'gwvdr*m'd; ql.cvw>zh;w>rr rhwrh> w>rrvxw>wl> vdmtdrohwz.< vxw>b.[h. rj;'h>cj (Medicare) 'D;Arhwrh> rj;'h>ch; (Medicaid) tyoruvhrtgtg*d>*d>vxtvd>w td.b.oh.wz.m.vdri

4 e,l,d;ud>pj.tw>od.w>odw>bsxwz. b.xgj'd;w>'k;ej.ed.*h> ui vxvhmw>vlrydmrrxgjw>bsxtw>&j.w>usjrtylr w>ymzsgxd.w>rrw>wwdwvdr (Qui Tam rhwrh> Whistleblower) tw>od.w>odwz. wtd.'d;w>rru.uhrw> w>ymzsgxd.w>vxturlrur. w>[h.w>ph.nd.wz. w>wrrckmrroud;vxrw> = w>xk;xd.ughmvxp&dylr -ux;vxuoh.ngw>ymyed.tywd>vxt*hrxd. = w>vjruymuhruymb.w>bsxthrwrh> w>wjylrzsj;o; vxw>wl>vdmtdrohb.m.vdri

5 w>vlrydmrrxgjw>bsxw>&j.w>usjrt*h>tusdrwz.i w>ugj;ymvdrusjoelwz.'d;w>rrusjoh.wz.y.ckm'd;w>oujmy0;tw>bsx'd;w>bsxvxw>ub.vlr ydmrrxgjtdrwz.m.vdri ysrrrw>zdud;*r'j;w>vd.b.t0joh.vxub.rrxgj0jw>od.w>od'd;w>bsxoh. wz.vxw>qg[h.ud;zsx.'j;tylr< ud>pj.'d;zj.'&x.ud>pxzsd.ud;bh.'j;tylrm.vdri w>oh.qxz;uwd>vxuxh.vdmo;'d;w>vlrydmrrxgjw>bsxtysrb.rlb.'g'd;w>vlrydmrrxgjw>bsx turh;whmzdw*ri w>od.vdvxub.[h.'d;w>[h.w>oh.nge>yx>tw>wdmusjrvxw>uvlrydmrrxgjw>od.w>odt*d>i w>qj;usd;qj;usxvxw>ymtdr'fw>clol.tw>rrusjvxtwkrxd.xd.b;'ftrh> hot line vdwjpdusdri usjoelt*krt*r= (w>[h.ul.[h.z;rl'gcd.aw>zh;w>rrrl'gcd.au&xcd.ch) Hot line vdwjpded.*h> (315) 235=7499I w>[h.w>ph.nd.tusjoelvxw>wvlrydmrrxgjw>bsxb.t*d>< 'D;w>ymzsgxD.w>wvlRydmrRxGJw>bsX t*h>wtd.i w>ckxh.oh.ngw>wvlrydmrrxgjw>bsxtw>vdrb.,d.tvd>wz.< 'D;w>pl;ugw>orHord;php&D'D;w> ug>pl.u,mw>[l;w>*jroh.wz.< 'ftrh>w>[h.u'gjp&d< w>rred.rrcgp&dywd>'d;w>xxekmvdrw>t rhrto.oh.wz.i w>cdqxu'guhrw>rrxd'gw>od.w>od'd;w>'k;td.xd.w>[h;*h>0dtw>&j.w>usjrvxubsdb.rrvdm uhrw>t*d>i w>wpl;ugw>rryshrrrzk;w>'d;w>wpl;ugw>rru.u'guhrw>wz. tusjoeli

6 w>vlrydmrrxgjw>bsxw>&j.w>usjrtw>ujbsk;wz.i w>uxk;ughm0jw>chphtd.vd;b.c;'d;w>orhord;php&d< w>chphtd.vd;vxtrh>ph 5<000 wkr 10<000 'Dv.vXw>ur.wcgt*D>tHRM.vDRI w>rrpsrvdrw>qxuwd>t,lmwz.< 'd;omrxd.to;vxcdyehmu&xw>wdw>vdrtw>tx.vdr (Corporate Integrity Agreement) rhwrh> (CIA) zj OIG rh>ej.vdr0jtcgi OIG urruykmvdrughm0jw>*h>'d;omrxd.to;vx CIA tzdcd.< ysr[h.w>qd.xgjrrpxrw> rrwz.b.oh.oh.wb.'d;vjysr[h.ul.w>vxw>csxvxuug>u'gpxrm>0jw>[h.u'gjp&dt w>zh;w>rrwz.t*d>< vxtyoruvhr'd.r;m.vdri w>ymzsgxd.qdw>[h.u'gjp&dvxtur.oh.wz.urrpsrvdr0jphxjthrxjekrvxw>ub.vd;u 'guhrtdrwz.m.vdri urr*hrxd.0jw>qj;usd;qj;usxvdmo;vxysr[h.w>qd.xgjwz.< ysrrrw>zdvxtxk;xd.u'gjp &D< 'D;w>td.ql.td.cVtw>rReD.rRCgtbX.pXRrh>'fod;urRvDRwH>0JvXu'GJp&D'D;w>rReD.rR CgeD.*H>eD.'G;wz.b.0JwD0Jt*D> (ysrqgvxttd.vxw>qg[h. 'D; ysrqgvxw>csx) M.vDRI

7 w>ymzsgxd.w>rrwwdwvdr (QUI TAM/WHISTLEBLOWER tw>od.w>odwz.) w>pl;ugtdrvxw>[h.*h>[h.bg0jysrw*rb.w*rvxu[j'd;ymzsgxd.0jw>chxd.vxturlrur. wz.t*d>i [h.tcgj;vxysrvxtoh.ngxgjw>chxd.vxturlrur.w*rv>v>vxuqsd;xd.w>*h>vx US rhwrh> ud>pj.y'd.tcx.p; ysrwjzsgxd.w>vhmw>vd (Whistleblower) M>ub.rh>0Jw>*h>w>usdRvXtw>rRM>tDRvX?t*H>xH;/ M.vDRI ub.qj;usd;0jysr[h.ql.cvw>ug>xgjtqduwx>'fod;'d;t0joh.u[h;rl'grrpxrw>vxeb.,d.b. bsdwz.t*d>m.vdri w>*h>w>usdrthrrhrh>wh>vhzj.'&x>tw>cdxhoh.ngtw>*h>cd.oh.wrhrwcd rhwrh> ysr[h.ql.cvw>ug> xgjthrrh>ymzsgxd.vhw>*h>w>usdrthrm.< ysrwjzsgxd.w>vhmw>vd EkmvDRy.CkmvXw>rRzsgxD.uhRw>tHR tylrwohb.m.vdri ysrwjzsgxd.w>vhmw>vd w*rrrm>0jw>[h.vruydrtdrb.c;w>vxy'd.rrm>u'guhrtdrvx 15 wkr 30 rs;u,rm.vdri w>rrcd.w*rrrxd'grru.u'guhr ysrwjzsgxd.w>vhmw>vd w*rwohvhrwuhrb.i

8 w>td.usd.td.phwwdwvdr'd;w>rrw&dwygw>t'dwz. w>chph[h.u'gjp&dvxw>zh;w>rr rhwrh> w>vxw>[h.vdrtdrwz.vxysrql;ysrqgw'd;m>0j ymzsgur.ysrql;ysrqgw*rtw>ql;w>qgt*h>tusdrrh>'fod;eurrb.vdmu'guhrusd.phw>tyoruvhr vxw>b.[h.ert*d>i Ch< [h.vdr< rhwrh> 'd;m>cd.z;vmqsd; rhwrh> w>chql.chuexrphvxysr[h.vdrw>wz. rhwrh> ysrqgm> w>wz.ttd.i bsdur.uoh.uodw>vd.oh.wz.tvhmtk.o;wz.< w>ulpg,gbsgtw>&j.w>usjrwz.< 'D;ql. cvw>ulpg,gbsgtw>rred.rrcgwz.'fod;'d;eurrb.vdmuhrusd.phw>tyorvxw>b.[h.ert*d>i [h.ysrw*r*rusd.phvxuqsxcdrysrqgw*rqletd. rhwrh> qlew>u&xu&dtylri [h.w>ej.vdr rhwrh> rrtd.xd.w>rrug>wz.vxtvd>wtd.0jvxql.cvw>ug>xgjt*d>wz.i xk;xd.u'gjp&dvxw>zh;w>rrwcgt*d>vxttgm>'h;w>zh;w>rrvxerrtdred>ed>< rhwrh>?ugj;tgxd. ed.*h>ed.'g;/i pl;ugysrt*rw*rtrj;'h>cj (Medicare) rhwrh> rj;'h>ch; (Medicaid ) tc;uhvxu'd;m>w>wdpxrrr pxrw>zh;w>rrt*d>i uwdrymudrcmql.cvw>rred.rrcgvxtwvxwysjrwz.m.vdri w>rred.rrcgw>*h>vdrwh>vdrqj; wz.w>ub.ugj;vdrtdrvxysrql;ysrqgtvhmwdrzsgtylrzjtvjr'd;yf;to;wbsdv>v>< ymzsgxd. b.c;w>vjr'd;ug>o;'d;w>zh;w>rrvxw>rrtdrwz.< y.ckm'd;w>rrug>tpxwz.m.vdri w[h.u'guhr0j rj;'h>ch; rhwrh> rj;'h>cj tusd.phvxw>[h.tgwvxb.tdrwz.vxtod 60 twd>ylrzjw> oh.ngb.vxw>[h.yd.b.phthr0hrtvd>chtqxuwd>m.vdri

9 ysrrrw>zdtrlt'grh>rekrvj.i erh>o; h Dw>tD.ubsH;tD.ubs.usd.phvXtwwDwvdR rhwrh> w>rrw&dwygw>m.< erle'gtd.vxeu b.[jymzsgxd.eo;'d;wjoud;tdrvxt*h>m.vdri w>vd.b.td.0jed>ed>vxw>ub.vlrydmrrxgj0j rj;'h>cj (Medicare) 'D; rj;'h>ch; (Medicaid) tw>od.w> od 'D; w>bsxoh.wz. 'D; w>qg[h.tw>rrusjoeloh.wz.m.vdri w>rh>vk.oh.cgywmw>bsxm.w>u ph.nd.tdr'd;w>qduwd>ughmtdrvxw>zh;w>rrtylroh0j'.m.vdri,-ux;qj;usd;'d;rw*rvj.i e0jrusdrtw>zh;w>rrrl'gcd.i ew>vlrydmrrxgjw>bsxtysrb.rlb.'g=vdwjpded.*h> (315) 798=8101I Hotline vdwjpded.*h> (315) 235=7499I

10 ,vjrrrm>vhmw>vlrydmrrxgjw>bsxtugj;'dwbh. ohvxw>vd>zjvj.i [D.cd.zdw>td.,XR0JRusdR (Human Resource Department). w>vlrydmrrxgjw>bsxtysrb.rlb.'g = vdwjpded.*h>tuwx> (extension) 8101I zj b.c;'d;ysr (about us) ubsh;yrtzdvmi e0jrusdrtw>zh;w>rrrl'gcd. rhwrh> w>th;xgjug>xgjw>rl'gcd.i

11 ed>up>w>o;pjwz.tw>b.*hm*lm w>o;pjtw>b.*hm*lmthrtcdyndrh>0jw>td.o;wcgzjysrrrw>zdw*r rhwrh> ysrvxw>emm>tdrw*rtw> qxwjmwz.'d;omrxd.to;vxted>up>'.0jtw>o;pjtzdcd.m.vdri tgwuh>w>thrb.xgjvdmto;'d; usd.ph*h>0dw>o;pj< b.q.b.oh.oh.uy.ckm'd;w>o;pjt*krt*roh.wz.m.vdri ysrw*rb.w*r rhwrh> bl;wh>w*rtd.'d;w>b.xgj rhwrh> EkmvDRrRCkmto;vXw>[l;w>*JRwcgtylRvX trr[;*dr rhwrh> vkmbxpdurdrtw>qxwjm< 'D;y.Ckm'D;w>b.qdurd.M>w>vXt0Joh.tw>rRup>wz. tw> o;pjm.vdri STEMC tysrrrw>zd'd;ysrvxtemm>0jcjvxmub.'k;oh.ngtysrth;xgjug>xgjw>rl'gcd. rhwrh> u&xw> vlrydmrrxgjw>bsxtysrb.rlb.'g (Corporate Compliance Officer) b.c;'d;w>td.o;wrhr v>v>zjt0joh.[l;*jrrrtrl'gvd>vrtqxuwd>< ed>up>w>o;pjtw>b.*hm*lmb.oh.oh.rh>td.0j< zjw>qx u uwd>vxt0joh.oh.ng0j'.w>o;pjtw>b.*hm*lmthrt*h>tcgm.vdri rh>wvdrwh>wcd< *hr'd.wuh>vxu ymzsgxd.w>td.o;thrtgm>'h;uwjzsgxd.w>wrhrrhrm.vdri w>rh>wymzsgxd. w>o;pjtw>b.*hm*lmwcg vxttd.xd.ohb.m.< b.oh.oh.w>tpxvxtutd.xd. M.rh>0Jw>u[H;*h>0DpH.nD.tDRM.vDRI t'd= 0JRusdRtw>zH;w>rRrl'gcd.w*RuwX.yD.oud;w>vXurRvHmCH;Cm'D;vD>u0DRcDyeHmwzsX.vXt [h.w>wdpxrrrpxrw>zh;w>rrql ql.cvw>th;xgjug>xgj0jrvd>wzsx.tylr< 'D;0JRusdRtw>zH;w>rRrl'gcd.tHR yxb.0j rhwrh> td.'d;usd.ph*h>0dw>o;pj (w>zdw>vhryehmvxtyxb.0j) vxcdyehmwzkm.tylrm.vdri

Department of Veterans Affairs Billing Guidelines for Health Care Provided to Veterans and Beneficiaries

Department of Veterans Affairs Billing Guidelines for Health Care Provided to Veterans and Beneficiaries Department of Veterans Affairs Billing Guidelines for Health Care Provided to Veterans and Beneficiaries Chief Business Office Purchased Care Department of Program Integrity (DPI) July 2013 Introduction

More information

Fraud, Waste & Abuse DEFICIT REDUCTION ACT OF 2005. Presented by: MARCH Vision Care, 2013

Fraud, Waste & Abuse DEFICIT REDUCTION ACT OF 2005. Presented by: MARCH Vision Care, 2013 Fraud, Waste & Abuse DEFICIT REDUCTION ACT OF 2005 Presented by: MARCH Vision Care, 2013 DISCLAIMER This training was created as a guide by MARCH and shall not be construed to contain all contractual requirements

More information

CORPORATE COMPLIANCE POLICIES AND PROCEDURES DRA NOTICE POLICY (CPL-007) Last Revision Date: September 9, 2014

CORPORATE COMPLIANCE POLICIES AND PROCEDURES DRA NOTICE POLICY (CPL-007) Last Revision Date: September 9, 2014 CORPORATE COMPLIANCE POLICIES AND PROCEDURES DRA NOTICE POLICY (CPL-007) Last Revision Date: September 9, 2014 Original Date: March 5, 2013 OMNICARE DRA NOTICE POLICY CPL-007 (SEPTEMBER 2014) I. PURPOSE

More information

TENNCARE POLICY MANUAL

TENNCARE POLICY MANUAL TENNCARE POLICY MANUAL Policy No: Pl 08-001 (Rev. 4) Subject: False Claims Act Policy Approval: Date: PURPOSE OF POLICY STATEMENT: The Bureau of TennCare is committed to its role in preventing health care

More information

B. Prevent, detect, and respond to unacceptable legal risk and its financial implications. C. Route non-compliance issues to appropriate areas.

B. Prevent, detect, and respond to unacceptable legal risk and its financial implications. C. Route non-compliance issues to appropriate areas. Policy Ashe Memorial Hospital (AMH) is committed to effective and efficient operations, reliable financial reporting and compliance with all applicable laws and regulations. It is the policy of AMH to

More information

ADMINISTRATION POLICY MEMORANDUM

ADMINISTRATION POLICY MEMORANDUM ADMINISTRATION POLICY MEMORANDUM POLICY TITLE: FRAUD AND ABUSE POLICY NUMBER: JCAHO FUNCTION AREA: POLICY APPLICABLE TO: POLICY EFFECTIVE DATE: POLICY REVIEWED: MCH-1083 Leadership All Employees January

More information

fraud, waste, abuse, compliance, integrity, Integrity Help Line

fraud, waste, abuse, compliance, integrity, Integrity Help Line Policy / Procedure: KEY TERMS: fraud, waste, abuse, compliance, integrity, Integrity Help Line I. PURPOSE: To help our employees, agents and contractors understand the methods to prevent and detect fraud,

More information

Overview of the Deficit Reduction Act and State False Claims

Overview of the Deficit Reduction Act and State False Claims Overview of the Deficit Reduction Act and State False Claims Massachusetts Extended Care Federation Lombardo's, Randolph, Massachusetts June 14, 2007 C. Elizabeth O Keeffe Foley & Lardner LLP Attorney

More information

W6 Negotiating False Claims Act Settlements and Corporate Integrity Agreements Roger Goldman, Felicia Heimer, Judith Waltz and Wendy Weiss

W6 Negotiating False Claims Act Settlements and Corporate Integrity Agreements Roger Goldman, Felicia Heimer, Judith Waltz and Wendy Weiss W6 Negotiating False Claims Act Settlements and Corporate Integrity Agreements Roger Goldman, Felicia Heimer, Judith Waltz and Wendy Weiss Health Care Compliance Association s 16 th Annual Compliance Institute

More information

Avoiding Medicaid Fraud. Odyssey House of Utah Questions? Contact your Program Director or Emily Capito, Director of Operations

Avoiding Medicaid Fraud. Odyssey House of Utah Questions? Contact your Program Director or Emily Capito, Director of Operations Avoiding Medicaid Fraud Odyssey House of Utah Questions? Contact your Program Director or Emily Capito, Director of Operations MEDICAID FRAUD OVERVIEW Medicaid Fraud The Medicaid Program provides medical

More information

Medicaid Fraud and Abuse Investigations, Prosecutions and Compliance Strategies

Medicaid Fraud and Abuse Investigations, Prosecutions and Compliance Strategies Combating Medicaid Fraud & Abuse: Implications of the Medicaid Integrity Program October 24, 2006 Medicaid Fraud and Abuse Investigations, Prosecutions and Compliance Strategies John T. Bentivoglio jbentivoglio@kslaw.com

More information

False Claims Act CMP212

False Claims Act CMP212 False Claims Act CMP212 Colorado Access is committed to a culture of compliance in which its employees, providers, contractors, and consultants are educated and knowledgeable about their role in reporting

More information

Colorado West HealthCare System Grand Junction, CO

Colorado West HealthCare System Grand Junction, CO Policy Title: Effective Date: 1/30/2008 Supersedes Date: N/A Colorado West HealthCare System Grand Junction, CO CWHS-WIDE POLICY FALSE CLAIMS ACT Responsible Departments: All Departments Administration

More information

Internal Investigations: Lucian E. Dervan Ford & Harrison LLP Melbourne, Florida (321) 724-5639

Internal Investigations: Lucian E. Dervan Ford & Harrison LLP Melbourne, Florida (321) 724-5639 Internal Investigations: The Hidden Danger of Whistleblower Suits Lucian E. Dervan Ford & Harrison LLP Melbourne, Florida (321) 724-5639 ldervan@fordharrison.com Welcome to the Age of the Whistleblower

More information

Federal False Claims Act

Federal False Claims Act Page 1 of 5 False Claims Recovery Policy HMSA must provide information about the following subjects to all HMSA employees and HMSA contractors and agents, who, on behalf of The HMSA Plan for QUEST Members,

More information

Fair Market Value and Payments to Healthcare Professionals How Should We Determine What We Pay? Huron Consulting Services LLC. All rights reserved.

Fair Market Value and Payments to Healthcare Professionals How Should We Determine What We Pay? Huron Consulting Services LLC. All rights reserved. Fair Market Value and Payments to Healthcare Professionals How Should We Determine What We Pay? Huron Consulting Services LLC. All rights reserved. Contact Information Debjit Ghosh Life Sciences Practices

More information

A summary of administrative remedies found in the Program Fraud Civil Remedies Act

A summary of administrative remedies found in the Program Fraud Civil Remedies Act BLACK HILLS SPECIAL SERVICES COOPERATIVE'S POLICY TO PROVIDE EDUCATION CONCERNING FALSE CLAIMS LIABILITY, ANTI-RETALIATION PROTECTIONS FOR REPORTING WRONGDOING AND DETECTING AND PREVENTING FRAUD, WASTE

More information

C O N F I D E N T I A L A N D P R O P R I E T A R Y. Page 1 of 7 Title: FRAUD, WASTE, AND ABUSE POLICY

C O N F I D E N T I A L A N D P R O P R I E T A R Y. Page 1 of 7 Title: FRAUD, WASTE, AND ABUSE POLICY Page 1 of 7 1. Purpose As a Company that does business with U.S. state and federal government health care programs (such as Medicare and Medicaid), Hill-Rom is required to maintain a system of policies

More information

Preventing Fraud, Waste, and Abuse

Preventing Fraud, Waste, and Abuse 2013 Compliance Training for Contractors and Vendors Module 2 Preventing Fraud, Waste, and Abuse For Internal Training Purposes Only 1 Learning Objectives After completing this training, learners will

More information

Compliance Lessons from Recent OIG Enforcement Activities. The Players. The Players Continued

Compliance Lessons from Recent OIG Enforcement Activities. The Players. The Players Continued Compliance Lessons from Recent OIG Enforcement Activities Sarah Duniway, Gray Plant Mooty Sara DeSanto, University of Minnesota Physicians July 14, 2015 The Players Office of Inspector General (OIG) Part

More information

To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center

To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center From: Corporate Compliance Department Re: Deficit Reduction Act of 2005 Dear Vendor/Agent/Contractor: Under the Deficit Reduction

More information

Corporate Compliance. Other Important Compliance Topics

Corporate Compliance. Other Important Compliance Topics Corporate Compliance & Other Important Compliance Topics Revised 5.2014 What is Corporate Compliance? Corporate Compliance means we strive to follow all the rules and regulations required of us as an organization,

More information

Deficit Reduction Act Information for Employees, Contractors and Agents

Deficit Reduction Act Information for Employees, Contractors and Agents Nationally Ranked. Locally Trusted. Denver Health Deficit Reduction Act Information for Employees, Contractors and Agents EFFECTIVE DATE: DECEMBER 31, 2006 PAGE 1 OF 5 Purpose: Provide a written policy

More information

HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual

HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual Fraud and Abuse Prevention DRA Compliance Policy #: 1521 Original Issue: December, 2007 Page 1 of 6 Policy It is the policy of Hackensack

More information

55144-1-5 Page: 1 of 5. Pharmacy Fraud, Waste and Abuse Policy. 1.0 Compliance Assurance. 2.0 Procedure

55144-1-5 Page: 1 of 5. Pharmacy Fraud, Waste and Abuse Policy. 1.0 Compliance Assurance. 2.0 Procedure Pharmacy Fraud, Waste and Abuse Policy 1.0 Compliance Assurance This Fraud Waste and Abuse Policy ( Policy ) reiterates the commitment of this pharmacy to comply with the standards of conduct established

More information

Policy No.: CP006_03 LC-07-01. Date Originated: Revision Date(s): 8/08, 3/11, 11/14. Date:

Policy No.: CP006_03 LC-07-01. Date Originated: Revision Date(s): 8/08, 3/11, 11/14. Date: Title: Federal False Claims Act Previous Title (if applicable): Department Applicability: All Lines of Business: All Originating Dept.: Compliance Policy No.: CP006_03 Supersedes Previous Policy No. (if

More information

Compliance with Applicable Federal and State Laws - False Claims Act and Similar Laws

Compliance with Applicable Federal and State Laws - False Claims Act and Similar Laws Laws - False Claims Act and Similar Laws Purpose The purpose of this policy ( Policy ) is to provide information regarding: the federal and state False Claims Acts ( FCA ), related administrative remedies

More information

Westlake Convalescent Hospital

Westlake Convalescent Hospital Title: False Claims Act Policy Manual: Administrative Policy Manual Category: Business function Approval Signatures: Westlake Convalescent Hospital Document #: Original Issue: 02/01/2006 Revision Date:

More information

USC Office of Compliance

USC Office of Compliance PURPOSE This policy complies with requirements under the Deficit Reduction Act of 2005 and other federal and state fraud and abuse laws. It provides guidance on activities that could result in incidents

More information

POLICY AND STANDARDS. False Claims Laws and Whistleblower Protections

POLICY AND STANDARDS. False Claims Laws and Whistleblower Protections POLICY AND STANDARDS Corporate Policy Applicability: Magellan BH (M) NIA (N) ICORE (I) Magellan Medicaid Administration (A) Corporate Policy: Policy Number: Policy Name: Date of Inception: January 1, 2007

More information

Stark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare

Stark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare Stark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare In health care, we are blessed with an abundance of rules, policies, standards and laws. In Health

More information

CORPORATE COMPLIANCE: BILLING & CODING COMPLIANCE

CORPORATE COMPLIANCE: BILLING & CODING COMPLIANCE SUBJECT: CORPORATE COMPLIANCE: BILLING & CODING COMPLIANCE MISSION: Quality, honesty and integrity, in everything we do, are important values to all of us who are associated with ENTITY NAME ( ENTITY NAME

More information

policy (C) Deficit Reduction Act of 2005 and the Federal False Claims Act

policy (C) Deficit Reduction Act of 2005 and the Federal False Claims Act Name of Policy: Detecting and Preventing Fraud, Waste and Abuse Policy Number: 3364-15-02 Issuing Office: President Responsible Agent: Compliance/Privacy Officer Revision date: July 5, 2011 Original effective

More information

False Claims Act NUMBER NH-LD-CP-220 Last Revised/Reviewed TITLE. Apr13. LD, CP Corporate Wide TJC FUNCTIONS APPLIES TO I.

False Claims Act NUMBER NH-LD-CP-220 Last Revised/Reviewed TITLE. Apr13. LD, CP Corporate Wide TJC FUNCTIONS APPLIES TO I. ADMINISTRATIVE TITLE False Claims Act NUMBER NH-LD-CP-220 Last Revised/Reviewed Effective Date: TJC FUNCTIONS APPLIES TO LD, CP Corporate Wide Apr13 I. SCOPE / PURPOSE It is the policy of Novant Health

More information

Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005

Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005 POLICY/PROCEDURE NO.: B-17 Effective date: Jan. 1, 2007 Date(s) of review/revision: Nov. 1, 2015 Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005

More information

Prepared by: The Office of Corporate Compliance & HIPAA Administration

Prepared by: The Office of Corporate Compliance & HIPAA Administration Gwinnett Health System s Annual Education 2014 Corporate Compliance: Our Commitment to Excellence Prepared by: The Office of Corporate Compliance & HIPAA Administration Objectives After completing this

More information

State False Claims Acts

State False Claims Acts State False Claims Acts How States Can Recover Stolen Money Jim Moorman, TAF Roderick Chen, OIG-HHS The Scope of the Fraud No one knows for sure how much fraud infects Medicaid and Medicare. The U.S. Government

More information

CODE OF CONDUCT. Our commitment to ethical conduct and compliance depends on all UHS personnel.

CODE OF CONDUCT. Our commitment to ethical conduct and compliance depends on all UHS personnel. CODE OF CONDUCT Our commitment to ethical conduct and compliance depends on all UHS personnel. If you find yourself in an ethical dilemma or suspect inappropriate or illegal conduct, discuss it with your

More information

Hospital Assocation of Southern California

Hospital Assocation of Southern California Hospital Assocation of Southern California Recent Developments in Fraud Enforcement and Litigation; Practical Strategies to Minimize Risks and Liabilities David V. Marshall davidmarshall@dwt.com U.S. Department

More information

Dan L. Hargrove Attorney at Law. The FALSE CLAIMS ACT

Dan L. Hargrove Attorney at Law. The FALSE CLAIMS ACT Dan L. Hargrove Attorney at Law The FALSE CLAIMS ACT If you can t do the time... Roadmap 1. History of the False Claims Act 2. What is the FCA 3. Types of fraud covered by FCA 4. How a case gets started

More information

VIDANT HEALTH POLICY & PROCEDURE. PREPARED BY: Office of Audit & Compliance REVISED: 11/09, 2/12 REVIEWED: 2/07, 2/08, 2/09, 3/10, 2/11

VIDANT HEALTH POLICY & PROCEDURE. PREPARED BY: Office of Audit & Compliance REVISED: 11/09, 2/12 REVIEWED: 2/07, 2/08, 2/09, 3/10, 2/11 NUMBER: VH-AC 16 Page 1 of 9 EFFECTIVE: 01/2007 REVIEWED: 2/07, 2/08, 2/09, 3/10, 2/11 CEO APPROVAL: Topic: To Prevent and Detect Fraud and Abuse and Information regarding the Federal False Claims Act

More information

NORTHCARE NETWORK. POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy

NORTHCARE NETWORK. POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy NORTHCARE NETWORK POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy RESPONSIBLE PARTY: Chief Executive Officer/Compliance Officer CATEGORY: Compliance BOARD APPROVAL

More information

AVOIDING FRAUD AND ABUSE

AVOIDING FRAUD AND ABUSE AVOIDING FRAUD AND ABUSE Responsibility, Protection, Prevention Presented by: www.thehealthlawfirm.com Main Office: 1101 Douglas Avenue Altamonte Springs, FL 32714 Phone: (407) 331-6620 Fax: (407) 331-3030

More information

Medicare Advantage and Part D Fraud, Waste, and Abuse Training. October 2010

Medicare Advantage and Part D Fraud, Waste, and Abuse Training. October 2010 Medicare Advantage and Part D Fraud, Waste, and Abuse Training October 2010 Introduction 2008: United States spent $2.3 trillion on health care. Federal fiscal year 2010: Medicare expected to cover an

More information

TM Nightingale. Home Healthcare. Fraud & Abuse: Prevention, Detection, & Reporting

TM Nightingale. Home Healthcare. Fraud & Abuse: Prevention, Detection, & Reporting Fraud & Abuse: Prevention, Detection, & Reporting What Is Fraud? Fraud is defined as making false statements or representations of facts to obtain benefit or payment for which none would otherwise exist.

More information

Amendments To The False Claims Act. July 7, 2009

Amendments To The False Claims Act. July 7, 2009 1 Amendments To The False Claims Act July 7, 2009 2 About this Webcast Need both browser & Webex open Rejoin webcast: Follow link in email Event number: 688 252 507 Event password: Cfca2009 Rejoin call:

More information

The term knowing is defined to mean that a person with respect to information:

The term knowing is defined to mean that a person with respect to information: Section 11. Fraud, Waste, and Abuse Introduction Molina Healthcare of [state] maintains a comprehensive Fraud, Waste, and Abuse program. The program is held accountable for the special investigative process

More information

False Claims / Federal Deficit Reduction Act Notice Help Stop Healthcare Fraud, Waste and Abuse: Report to the Firelands Corporate Compliance Officer

False Claims / Federal Deficit Reduction Act Notice Help Stop Healthcare Fraud, Waste and Abuse: Report to the Firelands Corporate Compliance Officer 1111 Hayes Avenue Sandusky, OH 44870 www.firelands.com False Claims / Federal Deficit Reduction Act Notice Help Stop Healthcare Fraud, Waste and Abuse: Report to the Firelands Corporate Compliance Officer

More information

Whistleblowers: What You Need to Know To Protect Your Agency

Whistleblowers: What You Need to Know To Protect Your Agency Whistleblowers: What You Need to Know To Protect Your Agency Presented by: Denise Bonn Deputy Director Center for Health Care Law National Association for Home Care & Hospice Denise-Bonn@nahc.org (202)

More information

How To Report Fraud At Care1St

How To Report Fraud At Care1St FRAUD AND ABUSE Arizona Revised Statute ARS 36-2918.01 requires providers to immediately report suspected fraud and abuse. Members or providers who intentionally deceive or misrepresent in order to obtain

More information

False Claims Act Violations and Corporate Compliance

False Claims Act Violations and Corporate Compliance False Claims Act Violations 31 U.S.C. 3729 The Players 1) Department of Justice (DOJ) enforces civil and criminal law 2) Office of Inspector General (OIG) cannot go to court has authority to administratively

More information

LOS ANGELES UNIFIED SCHOOL DISTRICT Policy Bulletin

LOS ANGELES UNIFIED SCHOOL DISTRICT Policy Bulletin TITLE: NUMBER: ISSUER: Federal False Claims Act Policy DATE: August 18, 2008 Judy Elliott, Chief Academic Officer Office of the Chief Academic Officer ROUTING All Employees All Locations Non-public Service

More information

Breakout Session: Sleepless Nights Legal Issues Keeping In-house Counsel Up at Night. Heather O Shea Jones Day

Breakout Session: Sleepless Nights Legal Issues Keeping In-house Counsel Up at Night. Heather O Shea Jones Day Breakout Session: Sleepless Nights Legal Issues Keeping In-house Counsel Up at Night Matthew Stennes Medtronic, Inc. Sanjay Narayan AbbVie Inc. Caryn McDowell Onyx Pharmaceuticals, Inc. John Kelly Bass,

More information

Lessons From Omnicare Settlement In 'Swapping' Cases

Lessons From Omnicare Settlement In 'Swapping' Cases Portfolio Media. Inc. 860 Broadway, 6th Floor New York, NY 10003 www.law360.com Phone: +1 646 783 7100 Fax: +1 646 783 7161 customerservice@law360.com Lessons From Omnicare Settlement In 'Swapping' Cases

More information

HCCA Managed Care Compliance Conference

HCCA Managed Care Compliance Conference HCCA Managed Care Compliance Conference Navigating the Affordable Care Act: Focus: Special Challenges for Managed Care Organizations Presented by: Stephen J. Weiser sweiser@meaderoach.com Navigating the

More information

The High Cost of Low Quality

The High Cost of Low Quality The High Cost of Low Quality Measuring the Economic Impact of Inadequate Quality of Care www.hcca-info.org 888-580-8373 Goals of the Presentation Pose the Question: Is Quality of Care a concern for Compliance

More information

How To Make A False Claims Law Work For The Federal Government

How To Make A False Claims Law Work For The Federal Government SB2730 TESTIMONY OF THE DEPARTMENT OF THE ATTORNEY GENERAL TWENTY-SIXTH LEGISLATURE, 2012 ON THE FOLLOWING MEASURE: S.B. NO. 2730, RELATING TO FALSE CLAIMS TO THE STATE. BEFORE THE: SENATE COMMITTEE ON

More information

CORPORATE COMPLIANCE POLICY AND PROCEDURE

CORPORATE COMPLIANCE POLICY AND PROCEDURE Title: Fraud, Waste, or Abuse (Whistleblower) Policy Policy # 1010 Sponsor: Corporate Approved by: Carleen Dunne, Director, Corporate and Privacy Officer Issued: Page: 1 of 6 June 25, 2007 Last Reviewed/Updated

More information

This policy applies to UNTHSC employees, volunteers, contractors and agents.

This policy applies to UNTHSC employees, volunteers, contractors and agents. Policies of the University of North Texas Health Science Center 3.102 Detecting and Responding to Fraud, Waste and Abuse Chapter 3 Compliance Policy Statement UNTHSC developed and implemented a Compliance

More information

Reports of Compliance Concerns and Violations

Reports of Compliance Concerns and Violations The University of Chicago Medical Center Compliance Manual (UCHHS;BSD;UCPP) Reports of Compliance Concerns and Violations Issued: November 1, 1999 Reports of Compliance Concerns and Violations Revised:

More information

Compliance and Program Integrity Melanie Bicigo, CHC, CEBS mlbicigo@uphp.com 906-225-7749

Compliance and Program Integrity Melanie Bicigo, CHC, CEBS mlbicigo@uphp.com 906-225-7749 Compliance and Program Integrity Melanie Bicigo, CHC, CEBS mlbicigo@uphp.com 906-225-7749 Define compliance and compliance program requirements Communicate Upper Peninsula Health Plan (UPHP) compliance

More information

Metropolitan Jewish Health System and its Participating Agencies and Programs [MJHS]

Metropolitan Jewish Health System and its Participating Agencies and Programs [MJHS] Metropolitan Jewish Health System and its Participating Agencies and Programs [MJHS] POLICY PURSUANT TO THE FEDERAL DEFICIT REDUCTION ACT OF 2005: Detection and Prevention of Fraud, Waste, and Abuse and

More information

Fighting Medicare Fraud More Bang for the Federal Buck

Fighting Medicare Fraud More Bang for the Federal Buck Fighting Medicare Fraud More Bang for the Federal Buck prepared for Taxpayers Against Fraud Education Fund by Jack A. Meyer President Economic and Social Research Institute APRIL 2005 Statement of Purpose

More information

2012-2013 MEDICARE COMPLIANCE TRAINING EMPLOYEES & FDR S. 2012 Revised

2012-2013 MEDICARE COMPLIANCE TRAINING EMPLOYEES & FDR S. 2012 Revised 2012-2013 MEDICARE COMPLIANCE TRAINING EMPLOYEES & FDR S 2012 Revised 1 Introduction CMS Requirements As of January 1, 2011, Federal Regulations require that Medicare Advantage Organizations (MAOs) and

More information

Addressing Government Investigations. Marcos Daniel Jimenez Partner

Addressing Government Investigations. Marcos Daniel Jimenez Partner Addressing Government Investigations Marcos Daniel Jimenez Partner November 14, 2014 Agenda Statistics Key Players Fraud and Abuse Laws Potential Consequences Mitigation Strategies 2 Key Health Care Fraud

More information

Partners Rx(X) CDMI(D) Nonsubstantive. Current Corporate Approval Date:

Partners Rx(X) CDMI(D) Nonsubstantive. Current Corporate Approval Date: Policy and Standards Product Applicability: Commercial Medicaid Medicare Part C Part D Business Division and Entity Applicability: Magellan Healthcare Magellan Healthcare(B) Magellan Complete Care(C) Magellan

More information

POLICY AND PROCEDURES MANUAL FRAUD, WASTE, AND ABUSE

POLICY AND PROCEDURES MANUAL FRAUD, WASTE, AND ABUSE Page Number: 1 of 7 TITLE: PURPOSE: FRAUD, WASTE, AND ABUSE The Harris County Hospital District implemented a Corporate Compliance Program in an effort to establish effective internal controls that promote

More information

Understanding Health Reform s

Understanding Health Reform s Compliance 101: Understanding Health Reform s New Compliance Requirements Uri Bilek Feldesman Tucker Leifer Fidell LLP Does your organization have a designated Compliance Officer? a. Yes b. No c. Don't

More information

Policies and Procedures

Policies and Procedures CITY OF PORTLAND MAINE Policies and Procedures NAME: FALSE CLAIMS IFRAUD, WASTE & ABUSE/WHISTELBLOWER PROTECTION RE: MEDICAREIMAINECARE PROGRAMS PURPOSE: The purpose of this Policy is to comply with the

More information

CODE OF CONDUCT And CORPORATE COMPLIANCE PLAN SUMMARY

CODE OF CONDUCT And CORPORATE COMPLIANCE PLAN SUMMARY CODE OF CONDUCT And CORPORATE COMPLIANCE PLAN SUMMARY Original Issue Date: October 2007 Revision Date: August 2013 Table of Contents Code of Conduct...1 Compliance Policies...3 A. General Business Practices...3

More information

Description of a First Tier, Downstream, and Related Entity

Description of a First Tier, Downstream, and Related Entity We at Health Partners Plans (HPP) would like to thank you for your partnership with HPP and helping us to provide exceptional service to our Medicare beneficiaries. The Centers for Medicare and Medicaid

More information

AHCA MEMBER GUIDANCE IMPLEMENTING THE FALSE CLAIMS ACT EDUCATIONAL PROVISIONS OF THE DEFICIT REDUCTION ACT

AHCA MEMBER GUIDANCE IMPLEMENTING THE FALSE CLAIMS ACT EDUCATIONAL PROVISIONS OF THE DEFICIT REDUCTION ACT AHCA MEMBER GUIDANCE IMPLEMENTING THE FALSE CLAIMS ACT EDUCATIONAL PROVISIONS OF THE DEFICIT REDUCTION ACT THE TOPIC: Section 6033 of the Deficit Reduction Act of 2005 ( DRA ) requires entities that make

More information

Federal False Claims Act (31 USC 3729 through 3733)

Federal False Claims Act (31 USC 3729 through 3733) I. INTRODUCTION The False Claims Act (FCA) is a federal law that was created to discourage and punish profiteers from providing sub-standard supplies to the Union Army during the Civil War. The FCA was

More information

False Claims, Exclusions, and Reporting Concerns

False Claims, Exclusions, and Reporting Concerns UT SOUTHWESTERN MEDICAL CENTER False Claims, Exclusions, and Reporting Concerns Honesty, Integrity, and Fairness should guide each member of our community in all actions and decisions. UT Southwestern

More information

Newport Subacute Healthcare Center

Newport Subacute Healthcare Center Title: False Claims Act Policy Manual: Administrative Policy Manual Category: Business function Approval Signatures: Newport Subacute Healthcare Center Document #: Original Issue: 02/01/2006 Revision Date:

More information

Multnomah County Department of County Human Services

Multnomah County Department of County Human Services Multnomah County Department of County Human Services Mental Health & Addiction Services Division Compliance Program Training Medicaid Fraud & Abuse 2014 Training Objectives THIS TRAINING DOES NOT LIMIT

More information

Why are so many DLA Piper employees certified in compliance? The risk of improper billing. David Piatt and Kelly Willenberg

Why are so many DLA Piper employees certified in compliance? The risk of improper billing. David Piatt and Kelly Willenberg Compliance TODAY April 2013 a publication of the health care compliance association www.hcca-info.org Why are so many DLA Piper employees certified in compliance? See page 16 22 What every compliance officer

More information

Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act

Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act SCOPE OF POLICY This policy applies to all CFS employees, including trainees, volunteers,

More information

Prevention of Fraud, Waste and Abuse

Prevention of Fraud, Waste and Abuse Procedure 1910 Responsible Office: Yale Medical Group Effective Date: 01/01/2007 Responsible Department: Administration Last Revision Date: 09/20/2013 Prevention of Fraud, Waste and Abuse Policy Statement...

More information

The Office of Inspector General (OIG) has turned its attention to fraud and abuse training

The Office of Inspector General (OIG) has turned its attention to fraud and abuse training Paving the Way: OIG Issues Fraud and Abuse Roadmap for Physicians Kathleen L. DeBruhl, Esquire and Lindsey E. Surratt, Esquire Kathleen L. DeBruhl & Associates, LLC New Orleans, LA The Office of Inspector

More information

MEMORIAL HERMANN HEALTH SYSTEM POLICY

MEMORIAL HERMANN HEALTH SYSTEM POLICY Page 1 of 5 MEMORIAL HERMANN HEALTH SYSTEM POLICY POLICY TITLE: False Claims Policy PUBLICATION DATE: 05/23/2014 VERSION: 2 POLICY PURPOSE: To comply with certain requirements set forth in the Deficit

More information

1 2 3 4 Currently, the government is extremely focused on cracking down on health care fraud. The government created the Health Care Fraud Prevention and Enforcement Action Team ( HEAT ) in May 2009 as

More information

Policies and Procedures SECTION:

Policies and Procedures SECTION: PAGE 1 OF 5 I. PURPOSE The purpose of this Policy is to fulfill the requirements of Section 6032 of the Deficit Reduction Act of 2005 by providing to Creighton University employees and employees of contractors

More information

FRAUD, WASTE & ABUSE. Training for First Tier, Downstream and Related Entities. Slide 1 of 24

FRAUD, WASTE & ABUSE. Training for First Tier, Downstream and Related Entities. Slide 1 of 24 FRAUD, WASTE & ABUSE Training for First Tier, Downstream and Related Entities Slide 1 of 24 Purpose of this Program On December 5, 2007, the Centers for Medicare and Medicaid Services ( CMS ) published

More information

UNITED HEALTHCARE COMMUNITY & STATE TENNCARE COMPLIANCE TRAINING 2016 MARCH VISION CARE PROVIDERS

UNITED HEALTHCARE COMMUNITY & STATE TENNCARE COMPLIANCE TRAINING 2016 MARCH VISION CARE PROVIDERS UNITED HEALTHCARE COMMUNITY & STATE TENNCARE COMPLIANCE TRAINING 2016 MARCH VISION CARE PROVIDERS Presented by Provider Relations 844.966.2724 x7576 2016, MARCH Vision Care AGENDA 1. CULTURAL COMPETENCY

More information

Oklahoma FALSE CLAIMS LAWS

Oklahoma FALSE CLAIMS LAWS Oklahoma Company-affiliated facilities in Oklahoma must ensure that all employees, including management, and any contractors or agents are educated regarding the federal and state false claims statutes

More information

How To Get A Medical Bill Of Health From A Member Of A Health Care Provider

How To Get A Medical Bill Of Health From A Member Of A Health Care Provider Neighborhood requires compliance with all laws applicable to the organization s business, including insistence on compliance with all applicable federal and state laws dealing with false claims and false

More information

TAANA 2015 Learn Lessons from CIAs: Decode the Documentation Demands

TAANA 2015 Learn Lessons from CIAs: Decode the Documentation Demands October 1, 2015 TAANA 2015 Learn Lessons from CIAs: Decode the Documentation Demands Kathleen Hessler, RN, JD Director, Compliance & Risk khessler@simione.com (505) 239-8789 WHO IS SIMIONE? Team of home

More information

THE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES FALSE CLAIMS AND WHISTLEBLOWER PROTECTIONS

THE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES FALSE CLAIMS AND WHISTLEBLOWER PROTECTIONS THE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES POLICY It is the obligation of the County of Montgomery (the County ) to prevent and detect any fraud, waste and abuse in its organization related to Federal

More information

I. Policy Purpose. II. Policy Statement. III. Policy Definitions: RESPONSIBILITY:

I. Policy Purpose. II. Policy Statement. III. Policy Definitions: RESPONSIBILITY: POLICY NAME: POLICY SPONSOR: FRAUD, WASTE AND ABUSE COMPLIANCE OFFICER RESPONSIBILITY: EFFECTIVE DATE: REVIEW/ REVISED DATE: I. Policy Purpose The purpose of this policy is to outline the requirements

More information

SCAN Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005

SCAN Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005 Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005 Approver Approval Stage Date Chris Zorn Approval Event (Authoring) 12/09/2013 Nancy Monk Approval Event

More information

Written: 1/09/07 Federal and State Reviewed: 3/15/12 False Claims Act Revised: 06/13/12 Page: 1 of 5

Written: 1/09/07 Federal and State Reviewed: 3/15/12 False Claims Act Revised: 06/13/12 Page: 1 of 5 Policy and Procedure Manual ADMINISTRATIVE SECTION --- III PATIENT RIGHTS & ORGANIZATIONAL ETHICS COMPLIANCE DEPARTMENT - COMPLIANCE Written: 1/09/07 Federal and State Reviewed: 3/15/12 False Claims Act

More information

Provider Education Webinars. Course 1: Coding in Health Care: Introduction and Purpose

Provider Education Webinars. Course 1: Coding in Health Care: Introduction and Purpose Provider Education Webinars Course 1: Coding in Health Care: Introduction and Purpose Community Health Plan of Washington Provider Education Webinar Course 1: Coding In Healthcare: Introduction and Purpose

More information

Jennifer Aldrich Civil Deputy Chief District of South Carolina

Jennifer Aldrich Civil Deputy Chief District of South Carolina Jennifer Aldrich Civil Deputy Chief District of South Carolina CAVEAT Anything in these slides or said by the speaker(s) do not represent the position of the Department of Justice or the South Carolina

More information

How To Protect Yourself From A False Claim

How To Protect Yourself From A False Claim False Claims Act Update Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 Email: bwade@kdlegal.com KD_4901979 1 The FCA is the Fraud Enforcement

More information

Case Study Success with a. into a Corporate Integrity Agreement (CIA)

Case Study Success with a. into a Corporate Integrity Agreement (CIA) Case Study Success with a Corporate Integrity Agreement (CIA) More than 100 affiliated physician practices and healthcare facilities Operations in multiple states More than 2,000 Covered Persons under

More information

COMPLIANCE WITH LAWS AND REGULATIONS (CLR)

COMPLIANCE WITH LAWS AND REGULATIONS (CLR) Principle: Ensuring compliance with applicable laws, regulations and professional standards of practice implementing systems and processes that prevent fraud and abuse. 91 Compliance with Laws and Regulations

More information

Corporate Compliance Education

Corporate Compliance Education Corporate Compliance Education Christopher J. Allman, Esq. Ottenwess, Allman & Taweel, PLC 535 Griswold, Suite 850 Detroit, MI 48226 313-965-2121 callman@ottenwesslaw.com Agenda Discuss the what and why

More information

Fraud, Waste & Abuse Prevention Awareness Training

Fraud, Waste & Abuse Prevention Awareness Training Fraud, Waste & Abuse Prevention Awareness Training Last Updated: July 30, 2013 What is Fraud, Waste and Abuse (FWA) Upon completion of this training you should be able to: Recognize and understand the

More information

Fraud, Waste and Abuse Training for Medicare and Medicaid Providers

Fraud, Waste and Abuse Training for Medicare and Medicaid Providers Fraud, Waste and Abuse Training for Medicare and Medicaid Providers For Use By: Licensed affiliates and subsidiaries of Magellan Health Services, Inc. Contents and Agenda Define Fraud, Waste, and Abuse

More information