General Compliance
Adherence to the laws and regulations passed by official regulating bodies and general principles of ethical conduct.
What is Compliance?
Defined by the Centers of Medicare and Medicaid Services (CMS) as the intentional deception or misrepresentation that an individual makes.
What is Fraud?
Any personal interests or activities that could influence judgment in the performance of duty to patients, partners, or the company.
Health Insurance Portability & Accountability Act of 1996.
What is HIPAA?
MUST NOT: be used for personal matters during work time; used to take photographs or videos of residents; used to text PHI, PII except through approved secure texting.
What is a cell phone or any personal electronic device?
Located in Fenton, MO where all of our medicines come from.
What is Network Pharmacy?
Defined by CMS as incidents or practices of providers that are inconsistent with sound medical practice and may result in unnecessary costs, improper payment, or the payment may fail to meet professionally recognized standards of care or are medically unnecessary.
What is Abuse?
Accepting gifts or money from patients, family members, vendors or referral sources.
Accepting tips from patients or family members.
What are possible conflicts of interest?
Name, Date of Birth, Exam/Lab Reports, Diagnosis, all information in Medical Records, all information in the billing financial folder, and Social Security numbers.
What is (PHI) Protected Health Information?
Any area of the building that residents are.
What is a patient care area?
Department of Health and Human Services HHS
Office of the Inspector General OIC
Centers of Medicare and Medicaid Services CMS
Department of Justice DOJ
Office for Civil Rights
What are Regulating Bodies?
Knowingly giving false or deceptive information resulting in an unauthorized benefit to himself or another person.
Fraud
Acceptable forms of appreciation from residents, family members or partners.
What are PEP cards?
Unauthorized acquisition, use or disclosure of information covered under HIPAA/HITECH rules which compromises the security and privacy of the information.
What is a Breach?
The only department authorized to take photos of residents.
What is Activities/Life Enrichment?
The regulating body for this building.
What is CMS?
Centers of Medicare and Medicaid Services
Laws to prevent and detect fraud and abuse.
What are False Claims Act of 1986 and 2009 and Deficit Reduction Act of 2005?
Emphasize the company's commitment to :Respecting patient rights, submitting accurate, truthful claims, complying with laws, protecting patient information, maintaining a safe, drug free workplace.
What are NHC's Standards of Conduct?
Appropriate disposal for any confidential, PHI or PII information.
What is the Shred Bin/Box?
In addition to being a HIPAA violation and can be considered Patient Abuse where criminal charges can occur.
What is inappropriate use of Social Media?
NHC participation in Medicare and Medicaid programs.
What is NHC MUST comply with Federal and State Regulations?
The False Claim Act that began during the Civil War, that targeted dishonest suppliers who overcharged or falsified records/bills to the government.
What is the Lincoln Law?
Responsible for keeping up to date personal certifications and licenses.
Who are licensed or certified individuals?
Privacy of Electronic Information that MUST NOT be shared or given to anyone.
What are Passwords and logins?
What is termination of employment?