{"ref":"MO-HC-ETH-03","title":"Compliance Program: Preventing and Detecting Improper Conduct","category":"Ethics","summary":"The Agency's program for preventing, detecting, reporting and resolving conduct that is improper or abusive of MO HealthNet, such as misappropriation of participant funds or property, falsified service delivery documents or agency records, false claims and kickbacks. It names a compliance lead, sets standards, training, monitoring and audits, a reporting route without retaliation, investigation, self-disclosure and repayment, conflict of interest rules, information on false claims laws, and the annual Deficit Reduction Act attestation to MMAC.","inShort":["Report anything that looks like fraud: false visit times, billing for care not given, missing participant money or changed records.","Tell your supervisor, Pat Sample, or the governing body. You can report without giving your name.","You will not be punished for reporting in good faith. Missouri and federal law protect people who report.","Never pay or accept anything for referring a participant.","The Agency looks into every report, fixes the problem and pays back any money it should not have received."],"primaryCitation":"13 CSR 70-3.030(3)","citations":["13 CSR 70-3.030(2)(D)","13 CSR 70-3.030(3)(A)3, 4, 8, 11, 12, 16, 24-27, 29-31, 35, 39","13 CSR 70-3.030(4)","13 CSR 70-3.030(6)","13 CSR 70-3.320(2)(I)","19 CSR 15-7.021(4)(A)1","RSMo 192.2475.9","RSMo 192.2480.1, .3, .9","MMAC In-Home Services Program Requirements 4.4, 5.7, 5.8","MMAC In-Home Services Proposal for Contract, Section VI item 4"],"federalCitations":["42 U.S.C. §1396a(a)(68)","31 U.S.C. §§3729-3733","31 U.S.C. §3730(h)","31 U.S.C. §3801 et seq.","42 U.S.C. §1320a-7b(b)","42 U.S.C. §1320a-7k(d)"],"surveyorAsks":["How would an aide report a suspected billing or EVV problem, and who looks into it?","Show me your last claims audit and what you did about the errors."],"forms":[{"ref":"MO-HC-ETH-03-A","title":"Compliance Concern Report"},{"ref":"MO-HC-ETH-03-B","title":"Annual Compliance Review and DRA Attestation Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (13 CSR 70-3.030(3))","5. Examples of Improper Conduct","6. Elements of the Compliance Program","7. Reporting a Concern","8. Investigation and Resolution","9. Overpayments and Self-Disclosure","10. Deficit Reduction Act Attestation and Annual Review","11. False Claims Laws and Protections for Those Who Report","12. Conflicts of Interest and Kickbacks","13. Responsibilities","14. Records and Compliance Monitoring","15. Staff Training","16. References","17. Related Policies and Forms","18. Approval","19. Revision History"],"version":"1.0","sample":false,"pack":"mo-hca","state":"Missouri","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}}