{"ref":"DC-HH-ETH-01","title":"Compliance Program, Exclusion Screening, False Claims, and Fraud Reporting","category":"Ethics","summary":"Sets up the Agency’s compliance program: a code of conduct, training on federal and District false claims laws and whistleblower protections, monthly exclusion screening of staff and contractors, a way to report concerns without retaliation, prompt investigation and correction, and immediate reporting of suspected Medicaid fraud to DHCF.","inShort":["Be honest in every note, timesheet, and bill. Never record care you did not give.","If you see something that may be fraud or a billing error, report it to the Director or a supervisor. You can report without giving your name.","Nobody will punish you for reporting a concern in good faith. The law protects whistleblowers.","You can also call the DC Medicaid fraud hotline at 1-877-632-2873.","We check every month that no staff member or contractor is banned from Medicare or Medicaid."],"primaryCitation":"29 DCMR §5012.7","citations":["29 DCMR §5012.7","29 DCMR §4222.15","29 DCMR §5014.3","29 DCMR §5014.4","29 DCMR §5001.2","D.C. Code §2-381.02","D.C. Code §2-381.04"],"federalCitations":["42 U.S.C. §1320a-7","42 U.S.C. §1396a(a)(68)","31 U.S.C. §3729","42 CFR §1001.1901","42 CFR §455.436","42 CFR §484.65(e)","42 CFR §484.105(e)(2)"],"surveyorAsks":["Who runs your compliance program, and how does the governing body oversee it?","Show me your exclusion screening for staff and contractors for the last three months."],"forms":[{"ref":"DC-HH-ETH-01-A","title":"Exclusion and Sanction Screening Log"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (29 DCMR §5012.7(l) and §4222.15)","5. Leadership and Written Standards","6. Training","7. Exclusion Screening","8. Reporting Concerns and Protection from Retaliation","9. Investigation and Corrective Action","10. Auditing and Monitoring","11. Informing Medicaid Beneficiaries","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"dc-hha","state":"Washington, DC","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}