Compliance Program, Exclusion Screening, and False Claims Prevention
Sets up the Agency’s compliance program: a person responsible for compliance, a code of conduct every staff member signs, training, a way to report concerns without retaliation, auditing, exclusion screening of every employee and contractor before hire and every month, and prompt correction of problems, including cooperation with NC Medicaid Program Integrity.
About this policy
- Policy number
- NC-HH-ETH-01
- Version
- 1.0
- Main rule
- 10A NCAC 13J .0906(a)
- Library
- North Carolina home health · 57 policies
- Category
- Ethics
- Sections
- 18
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 federal and NC Medicaid exclusion lists before hire and every month.
- Tell the office right away if you are ever excluded from Medicare or Medicaid.
What's inside
18 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (10A NCAC 13J .0906(a); 42 CFR §424.516(a)(3))
- 5. Code of Conduct
- 6. Compliance Officer and Governing Body
- 7. Reporting Concerns and Non-Retaliation
- 8. Exclusion Screening
- 9. Auditing and Monitoring
- 10. Investigation and Correction
- 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 responsible for compliance, and how does staff reach that person?
- Show me how you screened this employee against the federal and NC Medicaid exclusion lists, before hire and each month.
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