Compliance Program, Exclusion Screening, False Claims, and Fraud Reporting
Sets up the Agency’s compliance program: a code of conduct, training on federal and District false claims laws and whistleblower protections, monthly exclusion screening of staff and contractors, a way to report concerns without retaliation, prompt investigation and correction, and immediate reporting of suspected Medicaid fraud to DHCF.
About this policy
- Policy number
- DC-HH-ETH-01
- Version
- 1.0
- Main rule
- 29 DCMR §5012.7
- Library
- Washington, DC home health · 58 policies
- Category
- Ethics
- Sections
- 19
In short
- Be honest in every note, timesheet, and bill. Never record care you did not give.
- If you see something that may be fraud or a billing error, report it to the Director or a supervisor. You can report without giving your name.
- Nobody will punish you for reporting a concern in good faith. The law protects whistleblowers.
- You can also call the DC Medicaid fraud hotline at 1-877-632-2873.
- We check every month that no staff member or contractor is banned from Medicare or Medicaid.
What's inside
19 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (29 DCMR §5012.7(l) and §4222.15)
- 5. Leadership and Written Standards
- 6. Training
- 7. Exclusion Screening
- 8. Reporting Concerns and Protection from Retaliation
- 9. Investigation and Corrective Action
- 10. Auditing and Monitoring
- 11. Informing Medicaid Beneficiaries
- 12. Responsibilities
- 13. Records and Compliance Monitoring
- 14. Staff Training
- 15. References
- 16. Related Policies and Forms
- 17. Approval
- 18. Revision History
An inspector may ask
- Who runs your compliance program, and how does the governing body oversee it?
- Show me your exclusion screening for staff and contractors for the last three months.
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