{"ref":"CA-HSP-ETH-01","title":"Compliance Program, Referral Integrity and Fraud, Waste and Abuse","category":"Ethics","summary":"Sets out California's hospice referral integrity law (no payment to referral sources; paid recruiters may not counsel on hospice; only certain hospice-employed staff may counsel on election and complete consent), the eligibility, billing and records integrity rules that CDPH treats as grounds for discipline, and the Agency's fraud, waste and abuse program: training, monitoring, reporting, investigation and protection from retaliation.","inShort":["Never give or accept anything of value for a patient referral, not even a gift card or a meal.","If any of your pay depends on referrals or admissions, do not discuss hospice services, election or consent with patients or families.","Only a registered nurse, licensed vocational nurse, medical social worker, chaplain or counselor employed by the Agency may counsel a patient on electing hospice.","Document only care you actually gave, on the day you gave it, under your own login.","Report any concern about fraud, waste or abuse. You can report anonymously, and you will not be punished for reporting."],"primaryCitation":"Cal. Health & Safety Code §1746.50","citations":["Cal. Health & Safety Code §1746.50","Cal. Health & Safety Code §1746.52","Cal. Health & Safety Code §1755(a)(1)","22 CCR §74832(b)","22 CCR §74800(a)(19), (57)","22 CCR §74860(a)(2), (c)(3)(B)","22 CCR §74880(d)(4)(D)","22 CCR §74884(b)(14)","Cal. Bus. & Prof. Code §650","Cal. Welf. & Inst. Code §14107.2","Cal. Gov. Code §12650 et seq.","Cal. Gov. Code §12653","Cal. Lab. Code §1102.5"],"federalCitations":["42 U.S.C. §1320a-7b(b)","42 U.S.C. §1320a-7a(a)(5)","42 U.S.C. §1320a-7k(d)","42 U.S.C. §1396a(a)(68)","31 U.S.C. §3729 et seq.","31 U.S.C. §3730(h)"],"surveyorAsks":["Who counsels patients on electing hospice and completes the consent with them? Is any of them paid per referral or admission?","Do you give anything of value to physicians, facilities, discharge planners or anyone else who refers patients?"],"forms":[{"ref":"CA-HSP-ETH-01-A","title":"Annual Compliance and Referral Integrity Attestation"},{"ref":"CA-HSP-ETH-01-B","title":"Compliance Concern Report"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (Health & Safety Code §1746.50)","5. Referral and Marketing Rules","6. Eligibility Integrity","7. Billing and Records Integrity","8. The Fraud, Waste and Abuse Program","9. How to Report a Concern","10. Investigating and Correcting","11. Responsibilities","12. Records and Compliance Monitoring","13. Staff Training","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"ca-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}