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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.

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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:

1 Welcome

2  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

3  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

4 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

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6  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

7  False Claims Act  Anti-Kickback Statute  Physician Self- Referral Statute: (Stark Law)  Exclusion Statute  Civil Monetary Penalties Law

8 Prohibits the submission of false or fraudulent claims to the Government

9 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

10 Deliberate Ignorance

11  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

12 Incentives to report fraud  Up to 30% of any False Claims Act Recovery  Whistleblower Protections  More Info: Tax Payers Against Fraud-taf.org

13  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

14 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

15 Fines Prison Time Time Program Exclusion

16 Limits physician referrals when you have a financial relationship with the entity

17  Mandatory exclusions  Permissive exclusions Exclusion from Medicare and Medicaid

18 Three strikes and you’re out!

19 Civil Monetary Penalties Law Penalties range from $10,000 to $50,000 per violation

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21 Prevent and Detect:  Inaccuracies  Violations  Quality of Care Issues  Training Needs

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23 The Compliance Committee is established to advise the Compliance Officer and assist in the implementation of the Compliance Program.

24  New employees  Annually for all MH employees  Contract Providers

25 Non-Retribution, Non-Retaliation Policy

26 The toll-free confidential compliance line is: 1 -866-229-8050

27 www.whistleblowers.gov/

28 List of Excluded Individuals and Entities – LEIE

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30 PROVIDE HIGH QUALITY CARE BE ALERT & DISCLOSE ASK QUESTIONS DOCUMENTATION

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35 Stay Alert!

36 Toll Free Disclosure Line 1 -866-229-8050 Your call will be handled with utmost confidentiality and anonymity Your call will be handled with utmost confidentiality and anonymity.

37 Celeste Buckley..245-6957 Micki Mills…….....225-5075 Lynda Hughes…..225-5974 Sarah Hayes…….225-5201 Justina Larson….229-8266 Compliance Questions

38  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?

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