Just the PFHacts
A set of core values by which all associates, contracted providers and vendors must guide their behavior on behalf of PFH.
What is Code of Ethics?
(also acceptable, ICARE, Code of Conduct)
These associates are part of the Compliance team and can answer compliance related questions.
Who is: (any are acceptable)
Compliance Director
Privacy Director
Compliance Managers
CCEO
PHI stands for...
What is Protected Health Information?
This policy provides guidance for ethical conduct.
What is Code of Ethics (CE110)?
A legal document requesting testimony or records.
What is a subpoena?
Once a Compliance concern is discovered, the timeframe in which to report it.
What is immediately?
This online reporting system allows associates to report Compliance concerns anonymously should they so choose.
What is the Hotline?
ICARE is an acronym for............
What is Integrity, Competence, Accountability, Respect and Encouragement?
This policy protects associates who, in good faith, disclose a suspected or actual violation of state or Federal law, Federal health requirement, or Act of Misconduct from retaliation.
What is PFH's Non-retaliation policy (CE170)?
This federal law sets national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.
What is HIPAA (Health Insurance Portability and Accountability Act)?
This costs taxpayers billions of dollars each year
What is fraud, waste and abuse?
The ways in which to report a compliance concern to PFH's Office of Compliance and Ethics.
What is in person, by phone, by email, postal mail, or via the Hotline?
CMS stands for......
What is the Center for Medicare and Medicaid Services?
This policy requires all associates to report in good faith any suspected violations of any Federal healthcare program requirements, and/or other laws, regulations, PFH policies, practices and procedures to a Compliance Director, PFH’s Chief Compliance Officer or the 24-hour compliance line.
What is PFH's Compliance Reporting policy (CE200)?
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?
This policy states that that associates who, in good faith, report a suspected or actual violation of law, regulation, Code of Ethics, policy or procedure will not be subjected to retaliation, retribution, or harassment.
What is (CE170) Non-Retaliation?
The people responsible for ensuring Preferred family Healthcare acts responsibly & ethically.
Who are all PFH associates, and contracted providers.
OIG's mission is to provide objective oversight to promote the economy, efficiency, effectiveness, and integrity of HHS programs, as well as the health and welfare of the people they serve. OIG stands for......
What is the Office of Inspector General?
This policy prohibits associates and contracted providers from engaging in any activity, practice or act that conflicts with the interests of PFH, and requires disclosure of any potential or actual conflict.
What is PFH's Conflicts of Interest policy (CE150)?
This is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal health care program business.
What is the Anti-Kickback Statute?
Methods used by PFH and other healthcare providers to effectively detect & prevent fraud, waste & abuse.
What is auditing and monitoring?
According to policy CE121 Healthcare Program Integrity, PFH will self-report and return any overpayment involving Medicare or Medicaid to CMS or the applicable agency within this number of days after the date on which the overpayment was identified.
What is 60 days?
PFH has entered into an agreement with OIG, called a CIA.
The purpose of the CIA is to drive compliant behavior and set minimum standards for PFH to be held accountable. CIA stands for.........
What is Corporate Integrity Agreement?
According to CE121 Healthcare Program Integrity, _________ is defined as any funds that PFH receives or retains under any Federal health care program to which PFH, after applicable reconciliation, is not entitled under such Federal health care program. (regardless if it is die to fraud, waste, abuse, or simply an error)
What is overpayment?
Prohibits physician self-referral for Medicare and Medicaid patients.
What is Stark Law?