General
Liz Seatz
Who is the Compliance Officer?
All SMC employees
Who is responsible for billing compliance?
Physician recruitment is reviewed by
Who is CFO or CEO?
To provide excellence in Healthcare
What is the Mission Statement?
208-784-7017, Ext 555
What is Compliance Help Line?
All SMC employees, contractors, directors, vendors and professionals, officer and Board members
Who must carry out their duties in accordance with the Compliance Program?
Claiming reimbursement for services not rendered
Filing duplicate claims
Billing for length of stay beyond medically necessary
Billing excessive charges
What are examples of false claims?
A federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in 1986 has remained an unfunded mandate.
What is EMTALA?
A valley-wide healthcare system that assures the provision of quality services
What is the Vision Statement?
SMC encourages employees to contact their immediate supervisor and if necessary, proceed up the chain of command to resolve problems and concerns
What is Open Door Policy?
Report to Manager or Department Head or Compliance Officer
If an employee is aware of any violation of SMC policies they must
This act imposes liability on persons and companies who defraud governmental programs
What is the False Claims Act?
Encouraged healthcare providers to adopt electronic health records and improved privacy and security protections for healthcare data. This was achieved through financial incentives for adopting EHRs and increased penalties for violations of the HIPAA Privacy and Security Rules
What is HITECH Act?
Understand our patient's expectations
provide care and services in a timely and reasonable manner
be responsive to patient and family concerns
maintain patient rights and dignity at all time while under our care
What is your manager or the Compliance Officer?
To whom should you report charting errors?
Prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid
What is Anti-kickback?
Who should choose the hospital, diagnostic facility or supplier to be used by a patient
What is the patient's choice?
Hospital Districts are prohibited from making this contributions
What are political contributions?
A federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.
What is HIPAA?
To agree or attempt to agree with competitors to fix prices, divide geographic markets or make any agreement that raise the prices of our services or improperly reduces competitions
What are Antitrust law violations?
A Felony punishable by$25,000 fine and up to 5 years in prison
What is the punishment for violation of Anti-Kickback
Referrals based on a "financial relationship"
What is Stark Law?
What should you do if you receive a subpoena
Bring it to the CEO
If approached by a person that identifies him or herself as a government investigator you should
What is contact Corporate Compliance Officer or Administration?
What all employees, contractors and officer candidates are checked against
What is the Office of Inspector General Exclusion List?