LAWS
This protects people who report unethical or illegal behavior from retaliation or intimidation.
What is the Whistleblower Act?
The obtaining of something of value through intentional misrepresentation or concealment of material facts.
What is Fraud?
You are committing this if you bill for a service that you did not perform.
What is Fraud?
Chief Compliance Officer
Who is Adam Waxer?
OMIG
What is the Office of Medicaid Inspector General?
This makes it illegal for people to submit false statements or documentation in order to collect money from the government.
What is the False Claims Act?
Trainings that is required upon hire, then annually, and as needed
It is a violation of the Compliance Policy to do this when you are aware of fraudulent activity.
What is nothing or What is to not report it?
This who you can call to report false documentation or billing for visits that did not occur.
Who is the Compliance Officer or Compliance Hotline?
PHI
What is Protected Health Information?
This law prohibits remuneration in exchange for referrals of Federal Health Care Program business.
What is the Anti-Kickback Statute?
Obligations imposed by HIPAA and the Privacy and Security Rules
What are the requirements for HIPAA compliance training?
This is receiving a large gift in exchange for referrals.
What is a kickback?
This is who you call to report workplace harassment, acts of discrimination, or theft of your personal property.
Who is Human Resources or Compliance Department or Compliance Hotline?
CMS
What is the Center for Medicare and Medicaid Services?
This law prohibits a physician from referring Medicare or Medicaid patients to entities with which that physician has a financial relationship.
What is the Stark Law?
This program is mandated to set written policies and procedures for its employees, Independent Contractors, and Vendors.
What is the Corporate Compliance Program?
This occurs when a provider bills for a higher item or service codes than were actually performed, and it may result in a higher payment by Medicaid.
What is Upcoding?
This is who you call if you are asked to falsify documents so that the organization looks good at the next audit
Who is Compliance Officer or Compliance Hotline?
HHS
What is the Department of Health and Human Services?
CMS developed these regulations to specify payment and business practices that are guaranteed to not be considered kickbacks, bribes, or rebates under the Medicaid and Medicare programs
What is the Safe Harbor regulations?
These standards apply only to: health providers who transmit any health information electronically in connection with certain plans, health plans, and health care clearinghouses.
What is Health Insurance Portability and Accountability Act (HIPAA)?
A fraudster's illegal acquisition and use of person's private identifying information, usually for financial gain.
What is identity theft?
This is who you report incidents of fraud, waste, and abuse to if your supervisor(s) and the System's Compliance Officer fail to initiate an investigation.
Who is the CEO?
HITECH
What is Health Information Technology for Economic and Clinical Health?