Presentation on theme: "Welcome. To help you feel comfortable with asking questions. To inform you of whom to contact to ask questions To let you know that you are responsible."— Presentation transcript:
To help you feel comfortable with asking questions. To inform you of whom to contact to ask questions To let you know that you are responsible to disclose To share with you that you have a safe and confidential place to disclose
Promote a workplace culture of ethics and compliance Increase understanding of: State and Federal Healthcare Laws Shasta County’s policies Employee Responsibilities Promote compliance with federal health care program requirements
The ABC’s—Education Requirements: The Federal False Claims Act Administrative remedies for false claims and statements Any state laws pertaining to civil or criminal penalties for false claims and statements The whistleblower protections under such laws
Fraud includes obtaining a benefit through intentional misrepresentation or concealment of material facts Waste includes incurring unnecessary costs as a result of deficient management, practices, or controls Abuse includes excessively or improperly using government resources
Prohibits the submission of false or fraudulent claims to the Government
US Government pursues criminal and civil penalties for providers who: Have actual knowledge of fraud and abuse or Should have known about it when it occurs
US Department of Health and Human Services Office of Inspector General (OIG) Department of Justice (DOJ) /U.S. Attorneys FBI State Medicaid Fraud Control Units (MFCUs) Centers for Medicare & Medicaid Services (CMS) Postal Fraud Investigators Inspector General TRICARE Secret Service IRS
Incentives to report fraud Up to 30% of any False Claims Act Recovery Whistleblower Protections More Info: Tax Payers Against Fraud-taf.org
Billing for services not actually provided Upcoding and bill padding Billing for services that were not medically necessary Kickbacks Billing Medicare/Medicaid for a service that has already been paid for by another party Drug companies promoting a drug for a use for which it has not been approved Billing in order to increase revenue instead of billing to reflect actual work performed
The AKS prohibits soliciting or receiving anything of value, e.g., "in-kind” kickbacks, bribes or rebates in return for: Referring patients for Medicare covered services Buying an item or service covered by Medicare
Fines Prison Time Time Program Exclusion
Limits physician referrals when you have a financial relationship with the entity
Mandatory exclusions Permissive exclusions Exclusion from Medicare and Medicaid
Three strikes and you’re out!
Civil Monetary Penalties Law Penalties range from $10,000 to $50,000 per violation
Prevent and Detect: Inaccuracies Violations Quality of Care Issues Training Needs
The Compliance Committee is established to advise the Compliance Officer and assist in the implementation of the Compliance Program.
New employees Annually for all MH employees Contract Providers
Non-Retribution, Non-Retaliation Policy
The toll-free confidential compliance line is:
List of Excluded Individuals and Entities – LEIE
PROVIDE HIGH QUALITY CARE BE ALERT & DISCLOSE ASK QUESTIONS DOCUMENTATION
Toll Free Disclosure Line Your call will be handled with utmost confidentiality and anonymity Your call will be handled with utmost confidentiality and anonymity.
Do you feel comfortable to ask questions? Do you know to whom to contact to ask questions? Do you understand your responsibility to disclose? Do you know you have a safe and confidential place to disclose?