Compliance Program, Exclusion Screening, and False Claims Prevention
Sets up the Agency’s compliance program, with a code of conduct, a compliance officer, training, a confidential reporting line with no retaliation, auditing, and corrective action, and requires every employee and contractor to be screened against the Georgia Medicaid Exclusion List, the federal LEIE, and SAM before hire and every month.
About this policy
- Policy number
- GA-HH-ETH-01
- Version
- 1.0
- Main rule
- 42 CFR §1001.1901
- Library
- Georgia home health · 56 policies
- Category
- Ethics
- Sections
- 17
In short
- Follow the code of conduct and sign it every year.
- Report any concern about fraud, waste, or abuse to your supervisor or the compliance officer, Pat Sample. You can report anonymously.
- We will never punish you for reporting in good faith.
- We check every employee and contractor against the Georgia Medicaid and federal exclusion lists before hire and every month.
- Tell the office right away if you are ever excluded from Medicare or Medicaid.
What's inside
17 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (42 CFR §1001.1901 and Georgia Medicaid exclusion screening)
- 5. Elements of the Compliance Program
- 6. Exclusion Screening
- 7. Reporting Concerns and Non-Retaliation
- 8. Investigations and Corrective Action
- 9. False Claims Education
- 10. Responsibilities
- 11. Records and Compliance Monitoring
- 12. Staff Training
- 13. References
- 14. Related Policies and Forms
- 15. Approval
- 16. Revision History
An inspector may ask
- Who is your compliance officer, and how can staff report a concern confidentially?
- Show me your exclusion screening for this month: the Georgia Medicaid Exclusion List, the LEIE, and SAM.
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