FACTOIDS
The obtaining of 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 retribution.
What is the Whistleblowers' Provision of the False Claims Act?
This is who you can call to report false documentation or billing for visits that did not occur.
Who is the Corporate Compliance Office?
You are committing this if you bill for a service that you did not perform.
What is fraud?
OIG
What is the Office of Inspector General?
This is a set of guidelines that outlines ethical behavior for employees.
What are ethical standards/code of conduct?
This law 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?
This is who you call to report workplace harassment, acts of discrimination, or theft of your personal property.
Who is the Human Resources Department?
It is a violation of the Compliance Policy to do this when you are aware of fraudulent activity.
What is nothing? (What is to not report it?)
PHI
What is Protected Health Information?
This is the email used to report incidents of suspected non-compliance.
What is compliance@ceicmh.org?
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 the Human Resources Department?
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 Health Insurance Portability and Accountability Act (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 (also known as The Physician Self-Referral 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 Corporate Compliance Office?
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?
Under this provision of the Social Security Act, a HELP/PSI employee is prohibited from influencing a potential client by offering them a $15 gift card so that he or she will choose HELP/PSI as their Medicaid or Medicare provider.
What is the Anti-Inducement Provision?
CMS developed these regulations to specify payment and business practices that are guaranteed to not be considered kickbacks, bribes, or rebates under the Medicare and Medicaid programs.
What are the Safe Harbor regulations?
This is who you report incidents of fraud, waste, and abuse to if your direct supervisors and your organization's Corporate Compliance Officer fail to initiate an investigation.
What is the Board of Directors or Michigan Office of Inspector General?
An entity or individual that commits program-related crimes, patient abuse, felony health care fraud, or felony convictions relating to controlled substances may be excluded from participating in these programs.
What are Federal health care programs (i.e., Medicaid and Medicare)?
HITECH
What is Health Information Technology for Economic and Clinical Health?