{"ref":"PA-HC-ETH-02","title":"Compliance Program and Prevention of Fraud, Waste, and Abuse","category":"Ethics","summary":"Establishes the Agency’s compliance program: a compliance lead, written standards, training, an open door and anonymous reporting route, prompt investigation, correction and return of overpayments within 60 days of identification, and protection for people who report, with specific rules against the Medical Assistance prohibited acts and the federal false claims and anti-kickback laws.","inShort":["Only record and bill care that really happened, at the times it really happened.","Never give or take anything in return for a referral.","If you think something is being billed wrongly, tell Pat Sample or use the anonymous concern form.","You will not be punished for reporting a concern honestly."],"primaryCitation":"55 Pa. Code §1101.75","citations":["55 Pa. Code §1101.75","55 Pa. Code §52.21(d)(6)","55 Pa. Code §52.43","28 Pa. Code §611.4(c)"],"federalCitations":["31 U.S.C. §3729","31 U.S.C. §3730(h)","42 U.S.C. §1320a-7b(b)","42 U.S.C. §1396a(a)(68)","42 U.S.C. §1320a-7k(d)"],"surveyorAsks":["Who is responsible for compliance, and how can a worker report a concern anonymously?","What would you do if you found you had billed for a visit that did not happen?"],"forms":[{"ref":"PA-HC-ETH-02-A","title":"Compliance Concern Report"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (55 Pa. Code §1101.75)","5. Elements of the Compliance Program","6. Investigating a Concern","7. Referrals, Marketing, and Inducements","8. Protection for People Who Report","9. Responsibilities","10. Records and Compliance Monitoring","11. Staff Training","12. References","13. Related Policies and Forms","14. Approval","15. Revision History"],"version":"1.0","sample":false,"pack":"pa-hca","state":"Pennsylvania","service":"Home care","guides":[{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"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}}