Compliance Program and Prevention of Medicaid Fraud
Sets the Agency's compliance program for Medicaid and other public funds: the compliance lead, written standards, training, a way to report concerns without retaliation, auditing and monitoring, discipline, and correction, including how the Agency prevents and responds to fraud, waste, abuse, kickbacks and overpayments under Ohio and federal law.
About this policy
- Policy number
- OH-HC-ETH-03
- Version
- 1.0
- Main rule
- OAC 5160-1-17.2
- Library
- Ohio home care · 49 policies
- Category
- Ethics
- Sections
- 18
In short
- Record only what really happened. Never bill or record a visit that did not happen.
- Never sign for a client or copy a client's signature.
- Never give or take gifts or payments for client referrals.
- Report any billing or honesty concern to the Administrator. You can report without giving your name.
- You will not be punished for reporting in good faith.
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 (OAC 5160-1-17.2)
- 5. Elements of the Compliance Program
- 6. Rules Everyone Follows
- 7. Reporting Concerns
- 8. Investigation, Correction and Repayment
- 9. Auditing and Monitoring
- 10. Deficit Reduction Act Education
- 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 do staff report a concern?
- How do you audit your Medicaid claims against visit records?
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