FACTOIDS
This is the intentional misrepresentation of the truth or concealment of material facts in order to wrongfully obtain something of value or achieve unlawful financial gain.
What is Fraud?
This is who you can call to report false documentation or billing for items or services that were not provided.
Who is the Chief Compliance Officer?
You are causing this if you bill for a service that you did not perform.
What is a false claim?
OIG
What is Office of Inspector General?
This policy lays out the organization's principles, standards, proper practices, and moral and ethical expectations that employees are held to.
What is the Code of Conduct?
This law prohibits the submission of false statements or documentation in order to collect money from the government.
What is the False Claims Act?
It is a violation of the Code of Business Conduct and Compliance Program to do this when you are aware of fraudulent activity.
What is nothing (fail to report it)?
This program is designed to prevent, detect, and correct instances of noncompliance.
What is the Compliance Program?
This criminal statute prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs.
What is the Anti-Kickback Statute?
CalvertHealth's Chief Compliance Officer is:
Who is Patrick Garcia?
Receiving a large gift or any remuneration in exchange for patient referrals could violate this law.
What is the Anti-Kickback Statute?
This policy prohibits retaliation against any employee for reporting in good faith a compliance violation or concern.
What is Non-Retaliation Policy (HR 1-04)?
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 Chief Compliance Officer?
A coworker tells you she needs to leave work a few minutes early to catch her son’s high school game. She asks if you could clock her out of Kronos when you leave at the end of the shift. What should you do?
Tell your coworker you are not comfortable with her request to falsify her time card and risk both of you getting fired per company policy.
Tell her if she needs to leave early she should do so with her supervisor’s knowledge and approval.
According to policy HR 1-04 (Equal Employment Opportunity, Anti-Harassment/Discrimination and Non-Retaliation), how can an employee report harassment, discrimination or retaliation concerns/complaints:
Discuss with immediate supervisor
Contact a member of the Human Resources Dept.
Call the Compliance Hotline (410.535.8282)
This federal law requires health care providers to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge.
What is Health Insurance Portability and Accountability Act (HIPAA)?
You happen to be surfing a social website and you come across a negative comment about your organization that you believe is false. You want to respond and set the record straight. What should you do?
You are not authorized to speak on behalf of your organization and should not respond. Note the item and report it to your organization’s Public Relations Department.
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., Medicare and Medicaid)?
FCA
What is the False Claims Act?