Compliance Program and Prevention of Fraud, Waste, and Abuse
Establishes the Agency’s compliance program: a compliance lead, written standards, training, an open door and anonymous reporting route, prompt investigation, correction and return of overpayments within 60 days of identification, and protection for people who report, with specific rules against the Medical Assistance prohibited acts and the federal false claims and anti-kickback laws.
About this policy
- Policy number
- PA-HC-ETH-02
- Version
- 1.0
- Main rule
- 55 Pa. Code §1101.75
- Library
- Pennsylvania home care · 49 policies
- Category
- Ethics
- Sections
- 16
In short
- Only record and bill care that really happened, at the times it really happened.
- Never give or take anything in return for a referral.
- If you think something is being billed wrongly, tell Pat Sample or use the anonymous concern form.
- You will not be punished for reporting a concern honestly.
What's inside
16 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (55 Pa. Code §1101.75)
- 5. Elements of the Compliance Program
- 6. Investigating a Concern
- 7. Referrals, Marketing, and Inducements
- 8. Protection for People Who Report
- 9. Responsibilities
- 10. Records and Compliance Monitoring
- 11. Staff Training
- 12. References
- 13. Related Policies and Forms
- 14. Approval
- 15. Revision History
An inspector may ask
- Who is responsible for compliance, and how can a worker report a concern anonymously?
- What would you do if you found you had billed for a visit that did not happen?
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