Compliance Program, Referral Integrity and Fraud, Waste and Abuse

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.

Preview: full text with a package

About this policy

Policy number: CA-HSP-ETH-01
Version: 1.0
Main rule: Cal. Health & Safety Code §1746.50
Library: California hospice · 60 policies
Category: Ethics
Sections: 18

In short

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.

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 (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

An inspector may ask

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?

California hospice

Get it for your agency

All 60 California hospice policies, filled in with your details, in Word and PDF.

$1,100one-time · Policy Pack, required

The files are yours to keep. Includes 90 days in the portal with Premium; keep it after that for $109 a month or $1,090 a year.

Buy the Policy Pack See pricing

Rules it follows

Cal. Health & Safety Code §1746.50Cal. Health & Safety Code §1746.52Cal. 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 §650Cal. Welf. & Inst. Code §14107.2Cal. Gov. Code §12650 et seq.Cal. Gov. Code §12653Cal. Lab. Code §1102.542 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)

Forms included

CA-HSP-ETH-01-A Annual Compliance and Referral Integrity Attestation
CA-HSP-ETH-01-B Compliance Concern Report

Read a sample in full

Guides on this topic

See Cura Core with your agency's name on it.

Choose your state and type of agency, buy your Policy Pack online and get your sign-in by email. Already a customer? Sign in to your portal.

Get started Sign in