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Compliance Program, Exclusion and Suspended Provider Screening, and False Claims Prevention

Sets up the Agency’s compliance program: a code of conduct, a compliance officer, training, ways to report concerns without retaliation, monthly screening of every employee, contractor, owner, and governing body member against the federal exclusion list and the Medi-Cal Suspended and Ineligible Provider List, investigation and correction, and education about the federal and California false claims laws.

Preview: full text with a package
About this policy
Policy number
CA-HH-ETH-01
Version
1.0
Main rule
Cal. Welf. & Inst. Code §14043.61
Library
California home health · 58 policies
Category
Ethics
Sections
18

In short

  • Be honest in every note, timesheet, and claim.
  • Report any concern about fraud, abuse, or breaking the rules to your supervisor, the compliance officer, or the government. You can report anonymously.
  • No one is punished for reporting in good faith.
  • We check every worker every month against the federal and Medi-Cal exclusion lists. Tell us at once if you are ever excluded or suspended.
  • Never handle a patient’s money or accept gifts beyond a small token.

What's inside

18 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • 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 and Suspension Screening
  • 7. Reporting Concerns and Non-Retaliation
  • 8. Investigations and Corrective Action
  • 9. False Claims Education
  • 10. Code of Conduct
  • 11. Responsibilities
  • 12. Records and Compliance Monitoring
  • 13. Staff Training
  • 14. References
  • 15. Related Policies and Forms
  • 16. Approval
  • 17. Revision History

An inspector may ask

  • Who is your compliance officer, and how do staff reach them?
  • Show me your exclusion screening for last month. Which lists did you check?

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