Factoids
Obtaining something of value through intentional misrepresentation or concealment of material facts
What is Fraud?
This protects people who report unethical or illegal behavior from retaliation or intimidation.
What is the Whistleblower Act?
This is who you can call to report false documentation or billing for visits that did not occur
Who is the Compliance Officer?
You are committing this if you bill for a service that you did not perform
What is Fraud?
OMIG
This is a set of guidelines that outlines ethical behavior for employees
What is the Code of Conduct?
This law makes it illegal for people knowingly to submit false statements or documentation in order to collect money from the government
What is the False Claims Act?
This is who you call to report workplace harassment, acts of discrimination, or theft of your personal property.
Who is HR?
It is violation of the Compliance Policy to do this when you are aware of fraudulent activity.
What is to not report it? or What is nothing?
PHI
What is Protected Health Information?
This program is mandated to set written policies and procedures for its employees
What is the Corporate Compliance Program?
This law prohibits remuneration in exchange for referrals of Federal Health Care Program business
What is the Anti-Kickback Statute?
This is who you call if you have questions about the Earned Sick Time Act.
Who is HR?
This is receiving a large gift in exchange for referrals
What is a kickback?
HHS
What is the Department of Health and Human Services?
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 HIPAA?
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 is who you call if you are asked to falsify documents so that the organization looks good at the next audit.
Who is the Compliance Officer?
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?
CMS
What is the Center for Medicare and Medicaid Services?
Any employee, Independent Contractor or Vendor who works for the System may not accept what from anyone in connection with the business, either before, during or after a services or transaction is discussed or completed.
What is gifts?
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 are the Safe Harbor regulations?
This is who you report incidents of fraud, waste and abuse to if your direct supervisor(s) and the System's Compliance Officer fail to initiate an investigation.
Who is the CEO?
A fraudster's illegal acquisition and use of a person's private identifying information, usually for financial gain.
What is identity theft?
HITECH
What is Health Information Technology for Economic and Clinical Health?