Compliance Program, Exclusion Screening, and Fraud Prevention
Sets out the Agency’s compliance program: written standards and a code of conduct, a compliance officer, training, a safe way to report concerns, monthly exclusion screening, auditing, prompt correction and repayment, and protection for anyone who reports in good faith.
About this policy
- Policy number
- TX-HH-ETH-02
- Version
- 1.0
- Main rule
- 1 TAC §371.1655
- Library
- Texas home health · 56 policies
- Category
- Ethics
- Sections
- 18
In short
- Document only what you did, when you did it. Never back-date or sign for someone else.
- Report any concern about billing, records, or conduct to the compliance officer, Pat Sample, at (512) 555-0100.
- If the concern is about the Administrator, contact Jo Sample. You may report anonymously.
- You will never be punished for reporting in good faith.
- Tell the compliance officer at once if you are excluded from Medicare or Medicaid or your license is affected.
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 (1 TAC §371.1655)
- 5. Compliance Officer and Governing Body Oversight
- 6. Code of Conduct
- 7. Reporting a Concern
- 8. Exclusion Screening, Auditing, and Monitoring
- 9. Investigating, Correcting, and Repaying
- 10. Federal and State False Claims Laws
- 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 your compliance officer, and how does a nurse or aide report a concern without going through their supervisor?
- Show me your exclusion screening for this month for every employee and contractor, and what you would do with a match.
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