Please review the presentation below, Compliance, and then complete the accompanying quiz.
Employee Training Presentation
Compliance
Learning Objectives
After reading this training material you should be familiar with:
1. The United Medco Compliance Program
2. Overview of important compliance laws
3. Laws that govern healthcare compliance
4. How to report suspected non-compliance
Compliance and Ethics
What is compliance?
In its simplest form, compliance means following a rule or request. In healthcare, when we talk about compliance, we refer to following the rules, regulations, policies and laws created by the government, insurance programs and payers.
What is ethics?
Ethics simply means doing the right thing. Ethics goes beyond what is allowed by laws and regulations.
Compliance
A culture of compliance within United Medco:
UMI’s Compliance Program
A Compliance Program has been established at United Medco to assist our company in promoting our commitment to the highest legal and ethical standards.
This program has the commitment of everyone at UMI management, employees, vendors and others associated with UMI.
This program provides education, conducts investigations where there are allegations of misconduct, takes part in monitoring activities, such as audits, to assess areas of risk within the organization.
Compliance is part of all of our jobs and depends on everyone’s participation for continued success.
7 Elements of an Effective Compliance Program
• Compliance Officer
• Code of Conduct, Policies & Procedures
• Training and Education
• Effective Communication
• Disciplinary Guidelines
• Auditing and Monitoring
• Corrective Action/Responding to Reports
Benefits of an Effective Compliance Program
• Demonstrates commitment to honest and responsible conduct
• Increases the likelihood of preventing, identifying, and correcting unlawful behavior
• Avoids the potential for fraud, waste, and abuse
• Improves claim payment rate and reduces billing errors
• Early detection and reporting minimizes financial losses
Compliance Laws and Regulations
Stark Law - prohibits a physician from receiving payment for making a referral to an entity where they have ownership
Anti-Kickback Statute - receiving payment for referrals for service
False Claims Act - presenting a false claim for payment or approval
Exclusion - no Federal payment can be made to any individual or entity on the OIG exclusion report
F, W, & A - Fraud is obtaining something of value through misrepresentation; Waste is unnecessary costs; Abuse is excessive use of government resources
HIPAA - safeguards to unauthorized access to protected health care information.
Code of Conduct
The Code of Conduct is mandatory for all United Medco management, employees, and vendors. While the Code of Conduct provides a basic description of unacceptable conduct or performance it does not cover all behaviors that may occur in the workplace.
Noncompliance is conduct that does not conform to UMI’s ethical and business policies.
Failure to comply with the code is a serious matter and can lead to disciplinary action (up to and including termination).
Reference Code of Conduct
Code of Conduct Decision Making
At times, a difficult situation may present itself and the right decision may not be clear or easy to make
Doing the right thing is not always easy
There can be NO retaliation against you for reporting suspected noncompliance in good faith.
There are many resources available to help you determine if there is a law, regulation, policy, procedure or standard that would apply to a situation you are faced with including: your Supervisor, Compliance Officer, Compliance Hotline (954-947-4323)
Summary
UMI hopes this training has been both informative and helpful. The Compliance Manual is available for all employees
Feel free to review this presentation until you are confident about your knowledge of the material presented.
Take the self test when you are ready then sign the Acknowledgement to complete the requirements for this training.
Submit your Acknowledgement to the Compliance Officer.
Compliance QUIZ
Below is an 7 question quiz.
Complete your name and answer all 7 questions.
A score of 80% or better is required to pass
