{"ref":"CA-HC-ETH-03","title":"Compliance Program, Exclusion Screening, and False Claims","category":"Ethics","summary":"Sets up the Agency's compliance program: a responsible person, written standards, training, a way to report concerns without retaliation, screening of staff and contractors against the federal exclusion list and the Medi-Cal Suspended and Ineligible Provider List before hire and monthly, and prompt correction and repayment when a problem is found.","inShort":["Everyone who works for the Agency is checked against the federal and Medi-Cal exclusion lists.","Bill only for services that were actually delivered and documented.","Never offer or accept anything of value for client referrals.","Report any concern about fraud to the Administrator, or anonymously.","You are protected from retaliation when you report in good faith."],"primaryCitation":"Cal. Welf. & Inst. Code §14043.61","citations":["Cal. Welf. & Inst. Code §14043.61","Cal. Gov. Code §12651","Cal. Lab. Code §1102.5","Cal. Health & Safety Code §1796.38(e)"],"federalCitations":["42 U.S.C. §1320a-7","42 U.S.C. §1320a-7b(b)","31 U.S.C. §3729"],"surveyorAsks":["Who is responsible for compliance in your agency?","Show me your exclusion screening log for the last three months."],"forms":[{"ref":"CA-HC-ETH-03-A","title":"Exclusion Screening Log"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (Cal. Welf. & Inst. Code §14043.61)","5. Elements of the Compliance Program","6. Exclusion Screening","7. Claims, Referrals and Inducements","8. Responding to a Problem","9. Protection for People Who Report","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"ca-hca","state":"California","service":"Home care","guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}