False Claims Act CMP212
|
|
- Sherilyn Arnold
- 8 years ago
- Views:
Transcription
1 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 concerns and problems in relation to compliance and ethics. Colorado Access encourages employees, providers, contractors and consultants to report any concerns relating to potential fraud, waste, and abuse, including concerns related to false claims. No Colorado Access employee, provider, contractor or consultant will be discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated or retaliated against solely because of actions taken to report potential fraud, waste and abuse. The purpose of this policy is to provide an overview of key provisions of the False Claims Act (the FCA ) and related compliance requirements as required by the Deficit Reduction Act of 2005 (the DRA ) for Colorado Access. Justification: Regulatory Departments/LOBs Involved: All Referenced Polices: CMP201 Problem Reporting and Non-Retaliation CMP211 Fraud, Waste and Abuse Definition of Terms: False Claims Act: The FCA prohibits the knowing submission of unjustified or false claims to obtain federal funds, including Medicare and Medicaid programs. 1 Deficit Reduction Act of 2005: The DRA is a federal law requiring numerous changes to the Medicaid program. The DRA requires that entities that receive or make annual payments of at least five million dollars under a state Medicaid plan, as a condition of receiving or making such payments, establish and disseminate to all employees and certain contractors written policies that provide detailed information about: The Federal False Claims Act; Federal administrative remedies for false claims and statements; Whistleblower protections under Federal and state laws; Any state laws pertaining to civil or criminal penalties for false claims and statements; and Policies and Procedures for preventing and detecting fraud, waste and abuse. 2 Claim: The definition of claim under the FCA, includes any request or demand, whether under a contract or otherwise, for money or property which is made to a contractor, provider or other recipient, if the United States Government provides any portion of the money or property which is requested or demanded, or if the government will reimburse such contractor, provider, or other recipient for any portion of the money or property which is requested or demanded USC Social Security Act 1902(a)(68) 3 31 USC 3729(b)(2) Page 1 of 7
2 Knowing/Knowingly: The definition of knowing or knowingly under the FCA means that a person, with respect to information 4 : Has actual knowledge of the information; Acts in deliberate ignorance of the truth or falsity of the information; or Acts in reckless disregard of the truth or falsity of the information; and No proof of the specific intent to defraud is required. Whistleblower: The person who may bring a civil action for a violation of the FCA on behalf of the government. I. Detailed Information on the False Claims Act A. The FCA is a federal statute that prohibits fraud involving any federally funded program, including the Medicare and Medicaid programs. The FCA imposes liability on any person or entity who: 1. Knowingly presenting or causing to be presented a false or fraudulent claim for payment or approval; 2. Knowingly making, using, or causing to be made or used, a false record or statement to get a false or fraudulent claim paid or approved; 3. Conspiring to defraud by getting a false or fraudulent claim allowed or paid; 4. Delivering or causing to be delivered less property than the amount for which the person receives a certificate or receipt; 5. With intent to defraud, making or delivering a receipt without completely knowing that the information on the receipt is true; 6. Knowingly buying public property from a government employee who does not have the legal right to sell the property; and 7. Knowingly making or using a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the government. The FCA does not require proof of a specific intent to defraud for there to be a violation of the law. Examples of the types of activities prohibited by the FCA including billing for services that were not actually rendered, double-billing for items or services, upcoding (the practice of billing for a more highly reimbursed item or service than the one provided) or unbundling (the practice of billing services separately to secure a higher reimbursement). B. Administrative Remedies. The FCA establishes an administrative remedy against any person who presents or causes to be presented a claim or written statement that the person knows or has reason to know is false, fictitious, or fraudulent due to an assertion or omission to certain federal agencies (including the Department of Health and Human Services). The administrative remedy for violating the FCA is three times the dollar amount that the government is defrauded and civil penalties of $5,500 to $11,000 for each false claim by the party responsible for the claim USC 3729(b)(1) Page 2 of 7
3 1. Qui Tam Actions. The FCA provides for actions by private persons (qui tam lawsuit) to encourage individuals to come forward and report misconduct involving false claims. A qui tam action allows any person with actual knowledge of allegedly false claims to file a lawsuit on behalf of the U.S. government. Such persons are referred to as Whistleblowers. A qui tam lawsuit is initiated by Whistleblower on behalf of the government and is filed under seal (i.e., kept confidential) while the government reviews and investigates the allegations contained in the complaint. After the review and investigation period, the government may elect to join in the case in its own name or decide not to join in the case. If the government decides not to join in the case, the Whistleblower can continue with the lawsuit independently. If the lawsuit is successful, the Whistleblower may receive 15% to 30% of any recovery or settlement. The Whistleblower may also be entitled to reasonable expenses including attorney s fees and costs for bringing the lawsuit. 2. Whistleblower Protection. The FCA also includes anti-retaliation protections for Whistleblowers who make good faith reports of fraud, waste and abuse. The FCA prohibits retaliation against a Whistleblower for filing an action under the FCA or committing other lawful acts, such as investigating a false claim or providing testimony for, or assistance in, a FCA action. Any Whistleblower employee who is discharged, demoted, suspended, threatened, harassed or in any other manner discriminated or retaliated against in the terms and conditions of employment by his/her employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of an action under the FCA shall be entitled to all relief necessary to make the employee whole. Such relief shall include reinstatement, two times the amount of back pay plus interest and other costs, damages and attorneys fees and costs. 3. Miscellaneous Information. For the party that had responsibility for the false claim, the government may seek to exclude individuals suspected or convicted of violating the FCA from participation in federal health care programs or may impose other obligations, including the requirement that individual(s) or entities accused of violating the FCA enter into a Corporate Integrity Agreement. II. Colorado False Claims Statutes A. Medicaid Claims 5 The Colorado False Medicaid Claims statute makes it unlawful for any person or entity to: 1. Intentionally or with reckless disregard make or cause to be made any false presentation of a material fact in connection with a claim; 5 CRS to Page 3 of 7
4 2. Intentionally or with reckless disregard present or cause to be presented to the state department a false claim for payment or approval; 3. Intentionally or with reckless disregard present or cause to be presented any cost document required by the medical assistance program that the person knows contains a false material statement; 4. As to services for which a license is required, intentionally or with reckless disregard make or cause to be made a claim with knowledge that the individual who furnished the services was not licensed to provide such services. 5. Intentionally or with reckless disregard offers, solicits, receives or pays any remuneration (kickback, bribe, rebate) directly or indirectly, overtly or covertly, in cash or kind for referring an individual for any item or service paid under the medical assistance act or in return for purchasing, leasing, ordering, or arranging for any good, service, facility or item that is paid for under the medical assistance act. Any person or entity that violates provisions of this statute can be subject to civil penalties of between five thousand dollars ($5,000) to fifty thousand dollars ($50,000) per claim or two times the amount of all medical assistance received. Colorado law does not provide for qui tam actions or Whistleblower protections. B. Offering a False Instrument for Recording 6 The Colorado statute on offering a false instrument for recording provides criminal penalties for: 1. Presenting or offering a written instrument that contains a material false statement or material false information to a public office or a public employee with the knowledge or belief that it will be registered, filed or recorded or become a part of the records of that public office or public employee. 2. A person who violates this statute knowingly and with intent to defraud commits offering a false instrument for record in the first degree and is guilty of a felony. 3. A person who violates this statute knowingly commits offering a false instrument for record in the second degree and is guilty of a misdemeanor. III. Colorado Access Policies & Procedures: A. Incorporating the FCA into the Colorado Access Compliance Program 1. In addition to all other requirements of the current Colorado Access Compliance Program, Colorado Access will educate employees and others, as required by the DRA, about the Whistleblower provisions of the FCA which provide that no person will be subject to retaliatory action as a result of their reporting or pursuing information related to false claims, including false claims submitted by a provider, contractor, or consultant and/or employees, or others paying or arranging to pay false claims. 6 CRS Page 4 of 7
5 2. No Colorado Access employee will be discharged, demoted, suspended, threatened, harassed, or in any other manner retaliated against solely because of actions taken to report potential fraud, waste and abuse under the FCA (see policy and procedure CMP201 Problem Reporting and Non-retaliation). IV. Reporting Potential Fraudulent Activity A. Colorado Access employees, providers, contractors and consultants are encouraged and expected, as described in Colorado Access compliance training, Policies and Procedures, and Standards of Business Conduct, and the Colorado Access Employee Handbook, to bring forward concerns or complaints about compliance issues pertaining to Colorado Access business operations (see policy and procedure CMP201 Problem Reporting and Non-retaliation). This assists Colorado Access in investigating and correcting compliance issues, including those related to the FCA and DRA. B. The Colorado Access Compliance Program attempts, in part, to detect, investigate, prevent, minimize, and report potential or suspected instances of fraud, waste and abuse. It is the policy of Colorado Access that its employees, providers contractors, consultants, and agents report issues of suspected or potential fraud, waste and abuse to their supervisor, the Compliance Hotline ( ), a member of the Compliance Team, or the Colorado Access Compliance Officer. The reporting individual or party may request confidentiality and reports to the Compliance Hotline may be made anonymously. The employees of Colorado Access and any contractors, providers, consultants, and agents must make reasonable efforts to assist in detecting, investigating, reporting and preventing false claims and other fraudulent or abusive practices. C. While Colorado Access encourages employees, providers contractors, consultants, and agents to report instances of suspected fraud, waste and abuse as set forth in the prior paragraph, they may report fraud, waste, abuse, or misconduct directly to the Office of the Inspector General by: Online: Mail: Office of the Inspector General Department of Health & Human Services Attn: HOTLINE P. O. Box Washington, DC OIG Hotline: (800) HHS-TIPS (800) OIG Hotline Fax: (202) TTY: (800) D. Colorado Access shall report incidents of fraud, waste and abuse as set forth under policy and procedure CMP211 Fraud, Waste and Abuse. Page 5 of 7
6 V. Failure to Report Fraudulent Activity VI. An employee who fails to report, either through appropriate internal reporting channels or to governmental officials, when that person knows of conduct constituting a violation of the FCA or other compliance standards, may be subject to discipline, up to and including termination. Summary of Other Relevant Federal Laws A. Civil Money Penalties for False Claims in Federal Health Care Programs ( CMPL ) 7 Provides for monetary penalties against anyone who presents a claim to a federal or state officer, employee or agency that he or she knows or should have known was not provided as claimed. CMPL can also be imposed on a provider who: 1) submits a bill for services provided by a person who is not licensed or is excluded from federal or state health care programs; 2) violates the anti-kickback statute, or 3) violates the prohibition on physician self-referral, or Stark Laws. B. Criminal Penalties for False Claims in Federal Health Care Programs 8 A fine of up to $25, and/or imprisonment of up to five years may be imposed on any person in connection with the furnishing items of services under a federal health care program and who is convicted of a felony for knowingly and willfully: 1. Making a false statement or representation of material fact in any application for a benefit or payment under or for use in determining rights to such benefit or payment in a federal health care program; Concealing or failing to disclose, with intent to defraud, any event affecting his or her initial or continued right to any benefit or payment; 2. Presenting or causing to be presented a claim for a provider s service for which payment may be made under a federal health care program and knowing that the individual who furnished the service was not a licensed provider; or 3. For a fee counseling or assisting an individual to dispose of assets in order for the individual to become eligible for medical assistance under a state Medicaid program if disposing of the assets results in the imposition of a period of ineligibility for such assistance. C. Federal Anti-Kickback Statute 9 The Anti-Kickback Statute was designed to prevent fraud and abuse in federal health care programs by making it a crime for anyone to knowingly and willfully solicits or receives, or pays anything of value (remuneration) including any kickback, bribe, or rebate in return for referring an individual to a person for any item or service for which payment may be made in whole or in part under a federal health care program. Punishment for felony conviction for violating the anti-kickback law is a fine of not more than $25,000 or imprisonment for not more than five years, or both, administrative civil money penalties 7 42 USC 1320a-7a 8 42 USC 1320a-7b 9 42 USC 1320a-7b Page 6 of 7
7 of up to $50,000, and exclusion from participation in federal health care programs. The law contains several safe harbors that provide protection from prosecution for certain transactions and business practices with further guidelines provided in 42 C.F.R D. Federal Anti-Self-Referral Statute (Stark Laws) Subject to specific exceptions, prohibits a physician from referring federal health care program patients for certain designated health services to an entity with which the physician or an immediate family member has a financial relationship. No specific intent is required. A financial relationship is either a direct or indirect ownership interest or compensation arrangement. Certain regulatory exceptions apply. A physician who violates the Stark Laws is subject to substantial civil money penalties and exclusion from participation in the federal health care program for improper claims. The Stark Laws impose specific reporting requirements on entities that receive payment for services covered by federal health care programs. Failure to report would subject the entity to civil money penalty of up to $10,000 for each day for which reporting is required to have been made USC 1320 a-7b USC 1395(nn) Page 7 of 7
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 informationColorado 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 informationMETHODIST HEALTH SYSTEM ADMINISTRATIVE TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS
METHODIST HEALTH SYSTEM ADMINISTRATIVE Formulated: 6/19/07 Reviewed: Revised: Effective: 10/30/07 TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS PURPOSE: Methodist
More informationTo: 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 informationBehavioral Healthcare, Inc. 155 Inverness Drive West Suite 201 Englewood, CO 80112
1 of 6 I. Policy: It is the policy of Behavioral Healthcare, Inc. (BHI) that all employees (including management, consultants, contractors, and other agents) shall comply with all applicable Federal and
More informationThis 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 informationCoffee Regional Medical Center FALSE CLAIMS EDUCATION
Policy/Procedure Department Administration Effective 08/15/2008 Scope Organization Cross Reference Review Date 08/14/2008,12/18/2013 Revision History Signatures Date 12/18/2013 Prepared by Lavonda Cravey
More informationHow 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 informationHACKENSACK 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 informationTM 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 informationI. 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 informationCompliance with False Claims Act
MH Policy and Procedure Document Number: MH-COMPLY-001 Document Owner: Corporate Compliance Officer Date Last Author: Corporate Compliance Officer General Description Purpose: To establish written guidelines
More informationPolicy 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 informationUSC 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 informationVNSNY CORPORATE. DRA Policy
VNSNY CORPORATE DRA Policy TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005: POLICY REGARDING THE DETECTION & PREVENTION OF FRAUD, WASTE AND ABUSE AND APPLICABLE FEDERAL AND STATE LAWS APPLIES TO: VNSNY ENTITIES
More informationNORTHCARE 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 informationPOLICY 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 informationM INISTRY H EALTH CARE
M INISTRY H EALTH CARE CORPORATE POSITION STATEMENT TITLE: FRAUD AND ABUSE LAWS AND PROTECTIONS Origination Date: December, 2006 DRAFT/REV: December 7, 2007 Effective Date: January, 2007 Scope: Ministry
More informationFalse 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 informationCompliance 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 informationTitle: Preventing and Reporting Fraud, Waste and Abuse in Federal Health Care Programs. Area Manual: Corporate Compliance Page: Page 1 of 10
Title: Preventing and Reporting Fraud, Waste and Abuse in Federal Health Care Programs Area Manual: Corporate Compliance Page: Page 1 of 10 Reference Number: I-70 Effective Date: 10/02 Contact Person:
More informationNorth Shore LIJ Health System, Inc.
North Shore LIJ Health System, Inc. POLICY TITLE: Detecting and Preventing Fraud, Waste, Abuse and Misconduct POLICY #: 800.09 System Approval Date: 6/23/14 Site Implementation Date: Prepared by: Office
More informationPrevention 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 informationADMINISTRATIVE POLICY SECTION: CORPORATE COMPLIANCE Revised Date: 2/26/15 TITLE: FALSE CLAIMS ACT & WHISTLEBLOWER PROVISIONS
Corporate Compliance Plan AD-819-0 Reporting of Compliance Concerns & Non-retaliation AD-807-0 Compliance Training Policy CFC ADMINISTRATIVE POLICY AD-819-1 SECTION: CORPORATE COMPLIANCE Revised Date:
More informationHERITAGE FARM POLICY AND PROCEDURES. Policy: False Claims Act and Whistleblower Provisions
HERITAGE FARM POLICY AND PROCEDURES Policy: False Claims Act and Whistleblower Provisions Date: October 8, 2013 Rationale: It is Heritage Farm s intent to make sure all claims are submitted in a timely
More informationFraud, Waste and Abuse Prevention and Education Policy
Corporate Compliance Fraud, Waste and Abuse Prevention and Education Policy The Compliance Program at the Cortland Regional Medical Center (CRMC) demonstrates our commitment to uphold all federal and state
More informationTHE 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 informationUpper Peninsula Health Plan Policy & Procedure
Upper Peninsula Health Plan Policy & Procedure Index #: Effective: 01/01/07 Subject: State and Federal False Claims Revised: 05/18/11 Act, Whistleblower Protections CEO Approval: 01/01/07 Authorized By:
More informationNewYork-Presbyterian Hospital Sites: All Centers Hospital Policy and Procedure Manual Number: D160 Page 1 of 9
Page 1 of 9 TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005 FRAUD AND ABUSE PROVISIONS POLICY: NewYork- Presbyterian Hospital (NYP or the Hospital) is committed to preventing and detecting any fraud, waste,
More informationPITTSBURGH CARE PARTNERSHIP, INC. COMMUNITY LIFE PROGRAM POLICY AND PROCEDURE MANUAL. False Claims Act Explanation and Reporting Requirements
SUBJECT: False Claims Act Explanation and Reporting Requirements NUMBER: 1004 CROSS REFERENCE NUMBER: 1823 REG. REF.: 31 U.S.C. 37-29 PURPOSE: POLICY: The purposes of this policy are to describe the Federal
More informationVILLAGECARE CORPORATE COMPLIANCE POLICY AND PROCEDURE MANUAL ORIGINAL EFFECTIVE DATE: JANUARY 1, 2007
VILLAGECARE CORPORATE COMPLIANCE POLICY AND PROCEDURE MANUAL SUBJECT: COMPLIANCE WITH FEDERAL AND STATE FALSE CLAIMS LAWS AND DETECTION AND PREVENTION OF FRAUD, WASTE AND ABUSE LAST POLICY REVISION EFFECTIVE
More informationCOUNTY OF ORANGE. False Claims Act and Whistleblower Provisions Policy and Procedures
COUNTY OF ORANGE False Claims Act and Whistleblower Provisions Policy and Procedures COUNTY OF ORANGE FALSE CLAIMS ACT AND WHISTLEBLOWER PROVISIONS POLICY AND PROCEDURES I. Purpose. The County of Orange
More informationCHAMPAIGN COUNTY NURSING HOME SUMMARY OF ANTI-FRAUD AND ABUSE POLICIES
1. PURPOSE CHAMPAIGN COUNTY NURSING HOME SUMMARY OF ANTI-FRAUD AND ABUSE POLICIES Champaign County Nursing Home ( CCNH ) has established anti-fraud and abuse policies to prevent fraud, waste, and abuse
More informationMetropolitan 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 informationSOUTH NASSAU COMMUNITIES HOSPITAL One Healthy Way, Oceanside, NY 11572
SOUTH NASSAU COMMUNITIES HOSPITAL One Healthy Way, Oceanside, NY 11572 POLICY TITLE: Compliance with Applicable Federal and State False Claims Acts POLICY NUMBER: OF-ADM-232 DEPARTMENT: Hospital-wide CROSS-REFERENCE:
More informationFederal 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 informationfraud, 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 informationLast Approval Date: May 2008. Page 1 of 12 I. PURPOSE
Page 1 of 12 I. PURPOSE The purpose of this policy is to comply with the requirements in Section 6032 of the Deficit Reduction Act of 2005 (the DRA ), which amends Section 1902(a) of the Social Security
More informationCompliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures
CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE, NY and TOOMEY RESIDENTIAL AND COMMUNITY SERVICES Compliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures Purpose:
More informationADMINISTRATIVE POLICY MANUAL
SUPERSEDES: New PAGE: 838.00 POLICY: 1. It is the policy of Onondaga County hereinafter referred to as the County, to comply with all applicable federal, state and local laws and regulations, both civil
More informationFalse Claims and Whistleblower Protections All employees, volunteers, students, physicians, vendors and contractors
Policy and Procedure Title: Applies to: False Claims and Whistleblower Protections All employees, volunteers, students, physicians, vendors and contractors Number: First Created: 1/07 SY-CO-019 Issuing
More informationDeficit Reduction Act of 2005 6032 Employee Education About False Claims Recovery
DMH S&P No. 1 Revision No. N/A Effective Date: 01/01/07 COMPLIANCE STANDARD: Deficit Reduction Act of 2005 6032 Employee Education About False Claims Recovery BACKGROUND AND PURPOSE As stated in its Directive
More informationPOLICY ON FRAUD, WASTE AND ABUSE IN FEDERAL HEALTH CARE PROGRAMS
43 New Scotland Avenue (MC-12) Albany, NY 12208 POLICY ON FRAUD, WASTE AND ABUSE IN FEDERAL HEALTH CARE PROGRAMS EFFECTIVE JANUARY 1, 2007, APPROVED NOVEMBER 14, 2006 LATEST REVISION DATE: MARCH 4, 2015
More informationReports 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 information5037 Employee Education About False Claims Recovery 5037. The purpose of this policy is to educate employees, contractors, and agents on
5037 Employee Education About False Claims Recovery 5037 The purpose of this policy is to educate employees, contractors, and agents on the requirements of the Deficit Reduction Act (DRA) of 2005 which
More informationNOYES HEALTH ADMINISTRATION POLICY/PROCEDURE
NOYES HEALTH ADMINISTRATION POLICY/PROCEDURE SUBJECT: DETECTION AND PREVENTION OF POLICY: 200.161 FRAUD, WASTE, AND ABUSE EFFECTIVE DATE: June, 2012 ISSUED BY: Administration TJC REF: None PAGE: 1 OF 5
More informationSTATEN ISLAND UNIVERSITY HOSPITAL ADMINISTRATIVE POLICY AND PROCEDURE MANUAL
Page 1 of 10 POLICY: It is the obligation of the North Shore-Long Island Jewish Health System, Inc. 1 ( Health System ) and Staten Island University Hospital ( SIUH ) to prevent and detect any fraud, waste
More informationSCAN 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 informationFEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS
FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS I. FEDERAL LAWS False Claims Act (31 USC 3729-3733) The False Claims Act ("FCA") provides, in pertinent part, that: (a) Any person who (1) knowingly
More informationESTABLISHING POLICY AND PROCEDURES FOR COMPLIACE WITH 42 USC 139a(a)(68), False Claims and Whistle Blower Protections
RESOLUTION NO. COA-falseclaimsandwhistlesrev. 93-10 Date: 2/23/2010 ESTABLISHING POLICY AND PROCEDURES FOR COMPLIACE WITH 42 USC 139a(a)(68), False Claims and Whistle Blower Protections BY: Mr. George
More informationFalse 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 informationEDUCATION ABOUT FALSE CLAIMS RECOVERY
Type: MGI Corporate Policy Number: M 700 Effective Date: June 2014 Supersedes: AP 201, 4/12 Revised: 6/14 EDUCATION ABOUT FALSE CLAIMS RECOVERY I. PURPOSE This policy is intended to ensure compliance with
More informationA 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 informationpolicy (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 informationPolicies 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 informationPolicies 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 informationFraud, Waste and Abuse Page 1 of 9
Page 1 of 9 Overview It is the policy of MVP Health Care, Inc. and its affiliates (collectively referred to as MVP ) to comply with all applicable federal and state laws regarding fraud, waste and abuse.
More informationHow 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 informationCardinal McCloskey Services Corporate Compliance False Claims Act and Whistleblower Provisions
Cardinal McCloskey Services Corporate Compliance False Claims Act and Whistleblower Provisions Purpose: Cardinal McCloskey Services is committed to prompt, complete and accurate billing of all services
More informationPOLICY ON THE FALSE CLAIMS ACTS
EAST ORANGE GENERAL HOSPITAL COMPLIANCE POLICY Title: Policy on The False Claims Acts Code No.: Section: Corporate Compliance Effective Date: March 1, 2015 Approved by: Compliance Officer Publication Status:
More informationTENNCARE 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 informationOklahoma 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 information0 HealthAlliance. of the ~udsoti vallevtm J / YOUR PARTNERS IN HEALTH
0 HealthAlliance of the ~udsoti vallevtm J / YOUR PARTNERS IN HEALTH Policy: Compliance with Applicable Federal and State False Claims Acts Initiated: January 1,2010 Reviewed: Revised: Reference: Responsible
More informationThe 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 informationC 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 informationFEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS. 1) Federal False Claims Act (31 USC 3729-3733)
FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS I. FEDERAL LAWS 1) Federal False Claims Act (31 USC 3729-3733) II. NEW YORK STATE LAWS A. CIVIL AND ADMINISTRATIVE LAWS 1) New York False Claims
More informationCorporate Compliance Policy Concerning the False Claims Acts, Anti- Retaliation Protections, and Detecting and Responding to Fraud
PAGE NUMBER: 1 of 16 ACCOUNTABILITY: President and Chief Executive Officer OBJECTIVES: RELATION TO MISSION: Our Lady of Lourdes Health Care Services, Inc. ( OLLHCS, Inc. ), a Catholic health system and
More informationEXECUTIVE SUMMARY Compliance Program and False Claims Recovery
EXECUTIVE SUMMARY Compliance Program and False Claims Recovery INTRODUCTION: The Federal Deficit Reduction Act of 2005, also known as the DRA, requires that providers give their employees, medical staff,
More informationNewport 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 informationB. 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 informationSummary: The Organization directs its activities in full compliance with Federal, State and Local laws and regulations.
Sunrise Community, Inc. and Affiliates, the Organization, shall comply with Section 6032 of the Deficit Reduction Act of 2005. The Whistleblower Protection Policy is designed to encourage and enable directors,
More informationWestlake 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 informationSecondary Department(s): Corporate Investigations Date Policy Last Reviewed: September 28, 2012. Approval/Signature:
Subject: OBE-9 Fraud, Waste, and Abuse Detection and Prevention in Health Plan Operations Primary Department: Office of Business Ethics Effective Date of Policy: September 26, 2008 Plan CEO Approval/Signature:
More informationMEMORANDUM. 2. Public Health Solutions responds to questions and reports of fraud, waste, and abuse quickly.
MEMORANDUM To: Public Health Solutions staff providing Medicaid reimbursable services From: Jane Levine, Vice-President/General Counsel Re: Preventing Medicaid Fraud Summary of Public Health Solutions
More informationDetecting and Preventing Fraud, Waste and Abuse
Detecting and Preventing Fraud, Waste and Abuse Overview It is the policy of ICS to comply with all applicable federal and state laws regarding fraud, waste and abuse. ICS acknowledges its participation
More informationOSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS
OSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS POLICY: CC-109 It is the policy of OSF HealthCare (OSF) that false, inaccurate or improper claims will not be submitted to any payer.
More informationSULLIVAN COUNTY EMPLOYEE ORIENTATION FACT SHEET # 31
SULLIVAN COUNTY EMPLOYEE ORIENTATION FACT SHEET # 31 SULLIVAN COUNTY CORPORATE COMPLIANCE SUBJECT: FALSE CLAIMS ACT STATEMENT OF POLICY: Sullivan County is committed to providing quality health care in
More information55144-1-5 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 informationCOMPLIANCE AND OVERSIGHT MONITORING
COMPLIANCE AND OVERSIGHT MONITORING The contract between HCA and Molina Healthcare defines a number of performance requirements that must be satisfied by Molina Healthcare subcontracted Providers to provide
More informationFederal 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 informationWritten: 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 information2012-2013 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 informationMEMORIAL 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 informationThe Brody School of Medicine Policy and Procedure Manual
I. Purpose The purpose of this policy is to inform all employees, contractors, and agents of the Brody School of Medicine ( BSOM ) about (i) the federal False Claims Act; (ii) North Carolina Medical Assistance
More informationFRAUD, 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 informationFrequently Used Health Care Laws
Frequently Used Health Care Laws In the following section, a select few of the frequently used health care laws will be briefly defined. Of the frequently used health care laws, there are some laws that
More informationCombating Waste, Fraud, Abuse; Ability to Report Wrongdoing for Federal/Georgia Beneficiaries POLICY: AC.ETH.01.12
Combating Waste, Fraud, Abuse; Ability to Report Wrongdoing for Federal/Georgia Beneficiaries POLICY: AC.ETH.01.12 Responsible to: President & CEO Date: December 2005 PURPOSE It is the policy of Shepherd
More informationFraud, Waste and Abuse Compliance Policy
Fraud, Waste and Abuse Compliance Policy Introduction The federal and state governments have enacted laws, Section 6032 of the Deficit Reduction Act of 2005, effective January 1, 2005 and Chapter 36, Medicaid
More informationCENTERLIGHT HEALTH SYSTEM CORPORATE COMPLIANCE POLICY. SUBJECT: Detection & Prevention of Fraud, Waste & Abuse POLICY NO.:
EFFECTIVE DATE: January 1, 2007 PAGE: 1 of 8 Reference: Federal Deficit Reduction Act of 2005 (DRA) see, 6032 et seq; Office of the Medicaid Inspector General Provider Compliance guidance and CenterLight
More informationADMINISTRATION 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 informationFalse Claims Act Policy 650-117 Effective Date 01/01/2007 Compliance Manual
False Claims Act Policy 650-117 POLICY Monroe County Healthcare Authority is committed to the highest possible standards of ethical, moral and legal business conduct. Prevention of health care fraud, waste
More informationAlliance for Better Health Care, LLC
Alliance for Better Health Care, LLC ORGANIZATIONAL POLICY FALSE CLAIMS ACT AND WHISTLEBLOWER PROVISIONS Page 1 of 5 EFFECTIVE DATE: NUMBER: March 2015 ORIGINATOR: Corporate Compliance Officer CONCURRENCE:
More informationPOLICY 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 informationDEPARTMENT OF HUMAN SERVICES DIVISION OF DEVELOPMENTAL DISABILITIES
DEPARTMENT OF HUMAN SERVICES DIVISION OF DEVELOPMENTAL DISABILITIES DIVISION CIRCULAR #54 N/A EFFECTIVE DATE: November 19, 2008 DATE ISSUED: November 19, 2008 (Rescinds Division Circular #54 issued on
More informationHUNTERDON HEALTHCARE SYSTEM ADMINISTRATIVE POLICY AND PROCEDURE MANUAL
Page 1 of 12 Subcategory: I. POLICY It is the policy of Hunterdon Healthcare System (HHS) to be in compliance with all applicable federal and state laws, to enforce procedures designed to detect and prevent
More informationCORPORATE 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 informationDeficit Reduction Act Employee Information Requirements
November 9, 2006 Deficit Reduction Act Employee Information Requirements The Deficit Reduction Act ( DRA ) requires states participating in the Medicaid program to amend their State Plans to mandate that
More informationCAPITAL REGION MEDICAL CENTER ADMINISTRATIVE POLICY MANUAL
CAPITAL REGION MEDICAL CENTER ADMINISTRATIVE POLICY MANUAL ARTICLE: 5 SECTION: B SUBJECT: Leadership NUMBER: 79 DATE: January 1, 2007 SUPERSEDES Policy No. Dated: REVIEWED: March 24, 2010 PURPOSE The purpose
More informationLAKE COUNTY BOARD OF DD/DEEPWOOD BOARD POLICY I. SUBJECT: FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTION
File: E-11 LAKE COUNTY BOARD OF DD/DEEPWOOD BOARD POLICY Reviewed and Adopted by the Board: Date: February 28, 2011 Signature on file Elfriede Roman, Superintendent I. SUBJECT: FALSE CLAIMS PREVENTION
More informationCORPORATE 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